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Full text of "The American journal of the medical sciences"

Property of the 

Lancaster City and County 
Medical Society 



No 



THE 



AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 



EDITED BY 

ISAAC HAYS, M.D., 

SURGEON TO WILLS HOSPITAL. 

FELLOW OF THE PHILADELPHIA COLLEGE OF PHYSICIANS ; MEMBER OF THE 
AMERICAN MEDICAL ASSOCIATION ; OF THE AMERICAN PHILOSOPHICAL SOCIETY; OF THE 
ACADEMY OF NATURAL SCIENCES OF PHILADELPHIA, 
&C. &C.&C. 

NEW SERIES. 
YOL. XXYin. 




PHILADELPHIA: 
BLAN CHARD & LEA. 



1854. 



69454 



Entered according to the Act of Congress, in the year 1854, by 

BLANCH ARD AND LEA, 

in the Office of the Clerk of the District Court of the United States in and for the 
Eastern District of Pennsylyania. 




0.5 
Med. 

READERS AND CORRESPONDENTS. 
A number of communications are on hand whicli shall receive early attention. 
The following works have been received : — 

Health of the Navy. Statistical Reports on the Health of the Navy for the 
years 1837, 1838, 1839, 1840, 1841, 1842, and 1843. (In continuation of Pari. 
Paper, No. 436, of Sept. 1849.) Part II., East India Station. (Presented to 
Parliament by Her Majesty's command.) (From Sir William Burnett.) 

The Census of Ireland for the year 1851, Part III. Heport on the Status of 
Disease. Presented to both Houses of Parliament by command of Her Majesty. 
Dublin : 1854. (From the Census Commissioners of Ireland.) 

Epilepsy and other Affections of the Nervous System which are marked by 
Tremor, Convulsion, or Spasm ; their Pathology and Treatment. By Charles 
Bland Radcliffe, M. D., Licentiate of the Royal College of Physicians, Assistant- 
Physician to the Westminster Hospital, etc. London : 1854. (From the Author.) 

Lectures on the Diseases of Infancy and Childhood. By Charles West, M. D., 
Fellow of the Royal College of Physicians ; Physician to the Hospital for Sick 
Children, etc. Second American, from the second and enlarged London edi- 
tion. Philadelphia: Blanchard & Lea, 1854. (From the Publishers.) 

The Science and Art of Surgery; being a Treatise on Surgical Injuries, Dis- 
eases, and Operations. By John Erichsen, Professor of Surgery in University 
College, and Surgeon to University College Hospital. Edited by John H. 
Brtnton, M. D. Illustrated by three^hundred and eleven engravings on wood. 
Philadelphia: Blanchard & Lea, 1851. (From the Publishers.) 

Handbook of Chemistry, Theoretical, Practical, and Technical. By F. A. 
Abel, Professor of Chemistry at the Royal Military Academy, Woolwich, and 
Assistant-Teacher of Chemistry at St. Bartholomew's Hospital; and C. L. 
Bloxam, Formerly First Assistant to the Royal College of Chemistry. With a 
Preface, by Dr. Hoffman; and numerous illustrations on wood. Philadelphia: 
Blanchard & Lea, 1854. (From the Publishers.) 

Woman; her Diseases and Remedies. A Series of Letters to his Class. By 
Charles D. Meigs, M. D., Professor of Midwifery, and the Diseases of Women 
and Children in the Jefferson Medical College at Philadelphia, etc. etc. Third 
edition, revised and enlarged. Philadelphia: Blanchard & Lea, 1854. (Frobi 
the Publishers.) 

A Universal Formulary; containing the Methods of Preparing and Adminis- 
tering Officinal and other Medicines. The whole adapted to Physicians and 
Pharmaceutists. By R. Eglesfeld Griffith, M.D. A new edition, carefully 
revised and much extended. By Robert P. Thomas. With Illustrations. 
Philadelphia: Blanchard & Lea, 1854. (From the Publishers.) 

Lithographic Portrait of the late Robert Montgomery Bird. (From Dr. E. 
R. Mayer.) 

Diseases of the Heart and the Aorta. By William Stokes, Regius Professor 
of Physic in the University of Dublin, etc. Philadelphia: Lindsay & Blakiston, 
1854. (From the Publishers.) 

Types of Mankind ; or Ethnological Researches, based upon the Ancient 
Monuments, Paintings, Sculptures, and Crania of Races, and upon their Natural, 
Geographical, Philological, and Biblical History. Illustrated by Selections from 
the unedited papers of Samuel George Morton, M.D. (late President of the 
Academy of Natural Sciences, Philadelphia), and by Additional Contributions 
from Prof. Agassiz, LL.D., AV. Usher, M.D., and Prof. H. S. Patterson, M.D. 
By J. C. NoTT, M.D., of Mobile, Alabama, and Geo. R. Gliddon, formerly U.S. 
Consul at Cairo. Philadelphia: Lippincott, Grambo, & Co., 1854. (From the 
Publishers.) 

The Preservation of Health, with Remarks on Constipation, Old Age, Use of 
Alcohol in the Preparation of Medicines. By John C. Warren, M. D., Emeritus 
Professor of Anatomy and Surgery in Harvard University. Boston: 1854. 
(From the Author.) 

Remarks on some Fossil Impressions in the Sandstone Rocks of Connecticut 
River. By John C. Warren, M. D., President of the Boston Society of Natural 
History. Boston: 1854. (From the Author.) 



I 



4 



TO READERS AND CORRESPONDENTS. 



Clinical Lectures on Pulmonary Consumption. By Theophilus Thompson, 
M.D., F. R. S., Fellow of the Royal College of Physicians, London; Physician 
to the Hospital for Consumption and Diseases of the Chest, etc, Philadelphia: 
Lindsay & Blakiston, 1854. (From the Publishers.) 

Clinical Report on Dysentery; based on an Analysis of Forty-nine Cases ; with 
Remarks on the Causation, Pathology, and Management of the Disease. By 
Austin Flint, M. D., Professor of the Theory and Practice of Medicine in the 
University of Louisville, Ky. Buffalo: 1853. (From the Author.) 

Clinical Report on Chronic Pleurisy, based on an Analysis of Forty-seven 
Cases. By Austin Flint, M. D., Prof, of Principles and Pract. of Med. in the 
University of Buffalo, N. Y. Buffalo: 1853. (From the Author.) 

History of the Epidemic Yellow Fever at New Orleans, La., in 1853. By E. 
D. Fenner, M. D., one of the Visiting Physicians to the New Orleans Charity 
Hospital, etc. etc. New York : 1854. (From the Author.) 

Outlines of the Principles and Practice adopted in the Orthoposdic Institution 
of Brooklyn. By Louis Bauer, M. D., Physician and Surgeon (Berlin), etc. 
etc. ; and Richard Barthelmess, M. D., Physician and Surgeon (Wurzburg, 
Bavaria), etc. etc. New York : 1854. 

A Report to the Indiana State Medical Society on Asiatic Cholera, as it pre- 
vailed within the State of Indiana, during the years 1849, 1850, 1851, and 1852. 
With Observations on the Laws which govern its Progress. By George Sutton, 
M. D. Indianapolis : 1854. (From the Author.) 

Vaccination, and the Causes of the Prevalence of Smallpox in New York, in 
1853-'54. From the New York Journal of Medicine. By Joseph C. Hutchin- 
son, M. D., Physician to the Brooklyn City Dispensary. New York : 1854. 
(From the Author.) 

A Monograph on the Foetal Circulation. With three illustrations on wood. 
By E. R. Peaslee, A.M., M.D., Professor of Anatomy in Dartmouth College, 
and in the New York Medical College, etc. From the American Medical 
Monthly, May, 1854. New York : 1854. (From the Author.) 

A Critical Examination of a Pathological Specimen of Softening of Inverte- 
bral Fibro-Cartilages. From the New York Journal of Medicine. By Louis 
Bauer, M. D. New York : 1854. 

Transactions of the Fourth Annual Meeting of the Medical Society of the 
State of North Carolina. Held at Fayette ville, N. C, May, 1853. Wilmington, 
N. C: 1854. 

Transactions of the Medical Association of the State of Alabama. At its 
Seventh Annual Session, begun and held in the City of Montgomery, January 
10-12, 1854. With Constitution, Code of Medical Ethics, and List of Members. 
Mobile: 1854. 

Seventh Annual Report of the Regents of the University of the State of New 
York on the Condition of the State Cabinet of Natural History, and the His- 
torical and Antiquarian Collection annexed thereto. Made to the Senate, Jan. 
18, 1854. Albany : 1854. (From Dr. T. R. Beck.) 

Sixty-Seventh Annual Report of the Regents of the University of the State 
of New York. Transmitted to the Legislature, March 1, 1854. Albany: 1854. 
(From Dr. T. R. Beck.) 

Constitution and By-Laws of the Medical Association of Texas. Instituted 
January 17, 1853. Incorporated by the Fifth Legislature, 1853-1854. Pro- 
ceedings of the last Annual Meeting, together with the Anniversary Address. 
Delivered by Geo. Cupples, M.D., November, 1853. Austin: 1854. 

Report of the Board of Trustees of the Insane Asylum of the State of Califor- 
nia. Submitted to the Legislature, January 20, 1854. 

Eleventh Annual Report of the Managers of the State Lunatic Asylum of 
the State of New York. Transmitted to the Legislature, February 8, 1854. 
Albany: 1854. 

Thirty-Seventh Annual Report on the State of the Asylum for the Relief of 
Persons Deprived of the Use of their Reason. Published by direction of the 
Contributors, third month, 1854. Philadelphia: 1854. 

Remarks on the Efficiency of Quarantine, as a means of preventing the 
spread of Epidemic Diseases in cities and other populous communities ; being 



TO READERS AND CORRESPONDENTS. 



5 



the Anniversary Oration before the South Carolina Medical Association for 
1854. By Wii. T. Wragg, M. D. Charleston: 1854. (From the Author.) 

Annual Address before the Philadelphia County Medical Society. Delivered 
February 8, 1854. By -John F. Lamb, M.D., the late President. Published by 
the Society. Philadelphia: 1854. 

Lecture Introductory to the Course on Chemistry and Pharmacy in the Na- 
tional Medical College, Washington, D. C. By Lewis H. Steixer, M.D., Pro- 
fessor of Chemistry and Pharmacy. Delivered October 31, 1853. Chambers- 
burg, Pa. : 1853. 

Valedictory Address to the Graduates of the Medical Department of Pennsyl- 
vania College. Delivered at the Public Commencement, March 4, 1854. By 
JoHX J. Reese, M.D., Professor of Medical Chemistry and Pharmacy. Published 
by the Class. Philadelphia : 1854. 

Address to the Graduates of the Kentucky School of Medicine. Session, 
1853-'54. By R. J. Breceexridge, Professor of Materia Medica and Clinical 
Medicine. Published for the Graduates. Louisville : 1854. 

The following Journals have been received in exchange : — 

Gazette Medicale de Paris, January, February, March, April, 1854. 

Annales Medico-Psychologiques. Par MM. Les Docteurs Baillarger, 
Brierre de Bx)ismoxt et Cerise. January, April, 1854. 

Revue de Therapeutique Medicc-Chirurgicale. Par A. Martix Larvger. 
January, February, March, April, May, 1854. 

Le Moniteur des Hopitaux. Redacteur en chef M. H. De Castelxau. March, 
April, May, 1854. 

Archives d^Ophthalmologie comprenant les travaux les plus important sur 
I'Anatomie, la Physiologie, la Pathologic, I'Hygiene, et la Therapeutique de 
FAppareil de la Vision. Par M. A. Jamaix. January, February, March, 1854. 

Archives de Physiologie, de Therapeutique, et de Hygiene. Sous la direction 
de M, BoucHARDAT. January, 1854. 

Medical Times and Gazette. March, April, May, 1854. 

Dublin Medical Press. March, April, May, 1854. 

Association Medical Journal. Edited by Johx Rose Cormack, M.D. Febru- 
ary, March, April, May, 1854. 

The Edinburgh Medical and Surgical Journal. January, 1854. 

The Dublin Quarterly Journal of Medical Science. February, May, 1854. 

Monthly Journal of Medical Science. February, March, April, May, 1854. 

The Journal of Psychological Medicine and Mental Pathology. Edited by 
Forbes Wixslovt, M.D. April, 1854. 

The British and Foreign Medico-Chirurgical Review. April, 1854. 

The Medical Chronicle or Montreal Monthly Journal of Medicine and Sur- 
gery. Edited by Drs. Wright and McCALLUir. April, May, June, 1854. 

The Peninsular Journal of Medicine and the Collateral Sciences. Edited by 
E. AxDREWS, A.M., M.D. March, April, May, June, 1854. 

The Stethoscope. Edited by Drs. Atkixsox, Haxall, Boltox, Lewis, Mer- 
RiTT, and Cabell. April, May, June, 1854. 

The Medical Examiner. Edited by Samuel L. Hollixgsworth, M.D. April, 
May, June, 1854. 

New York Medical Times. Edited by Hexrt D. Bclklet, M. D. April, 
May, June, 1854. 

Memphis Medical Recorder. Edited by A. P. Merrill, M.D., and C. T. 
QuixTARD, M. D. March, May, 1854. 

St. Louis Medical and Surgical Journal. Edited by M. L. Linton, M.D., and 
Wm. M. McPheeters, M. D. March, May, 1854. 

The New York Medical Gazette. Edited by D. Meredith Reese, M. D. April, 
May, June, 1854. 

The Western Journal of Medicine and Surgery. Edited by Lunsford P. 
I^axdell, M.D. November and December, 1853 ; March, April, May, 1854. 

Southern Medical and Surgical Journal. Edited by L. A. Dugas, M. D. 
April, May, June, 1854. 

The American Medical Monthly. Edited by E. H. Parker, M. D. April, 
May, June, 1854. 



6 



TO READERS AND CORRESPONDENTS. 



The New Jersey Medical Reporter. Edited by S. W. Butler, M. D., and 
Jos. Parrish, M. J). April, May, June, 1854. 

The New Hampshire Journal of Medicine. Edited by G. H. Hubbard, M. D. 
April, May, June, 1854. 

The Boston Medical and Surgical Journal. Edited by J. V. C. Smith, M.D., 
and G. S. Jones, M. D. April, May, 1854. 

New York Journal of Pharmacy. Edited by Drs, Antisell, Torret, and 
Ederlin", and Benjamin Canavan. April, June, 1854. 

Buffalo Medical Journal. Edited by Austin Flint, M. D., and S. B. Hunt, 
M. D. April, May, June, 1854. 

The Medical Reporter. A Quarterly Journal. Published under the direction 
of the Chester and Delaware County Medical Societies. April, 1854. 

The North-Western Medical and Surgical Journal. Edited by W. B. Her- 
RiCK, M. D., and H. A. Johnson, M. D. March, April, 1854. 

New Orleans Medical News and Hospital Gazette. Edited by Drs. Choppin, 
Beard, Schlater, and Boyer. March, April, May, June, 1854. 

Kentucky Medical Recorder. Edited by H. M. Bullitt, M.D., and R. J. 
Breckenridge, M. D, March, April, May, 1854. 

The American Journal of Science and Arts. Conducted by Profs. B. Silli- 
man, B. Silliman, Jr., and James D. Dana, in connection with Profs. Gray and 
Agassiz, and Drs. Burnett and Gibbs. May, 1854. 

American Journal of Pharmacy. Edited by Wm. Proctor, Jr. May, 1854. 

The American Journal of Dental Science. Edited by Drs. Harris, Blandy, 
and Piggot. April, 1854. 

The Western Lancet. Edited by L. M. Lawson, M. D., and T. Wood, M. D. 
April, May, June, 1854. 

The Virginia Medical and Surgical Journal. Edited by G. A. Otis, M. D., 
and J. B. McCaw, M. D. April, May, 1854. 

The New York Journal of Medicine and the Collateral Sciences. Edited by 
S. S. Purple, M.D., and S. Smith, M.D. May, 1854. 

The Ohio Medical and Surgical Journal. Edited by John Dawson, M.D. 
May, 1854. 

The American Journal of Insanity. Edited by T. Romeyn Beck, M. D. April, 
1854. 

The Southern Journal of the Medical and Physical Sciences. Edited by Drs. 
King, Jones, Currey, Wood, Ramsay, and Atchison. May, 1854. 

The New Orleans Medical and Surgical Journal. Edited by Bennett Dow- 
ler, M. D. May, 1854. 

The Charleston Medical Journal and Review. Edited by D. J. Cain, M. D., 
and F. Peyre Porcher, M. D. May, 1854. 

The Western Medico-Chirurgical Journal. Edited by J. F. Sanford, M.D. 
March. 

Iowa Medical Journal. Conducted by the Medical Department of Iowa Uni- 
versity. May, 1854. 

Communications intended for publication, and Books for Eeview, should be sent, free 
of expense, directed to Isaac Hays, M. D., Editor of the American Journal of the Me- 
dical Sciences, care of Messrs. Blanchard & Lea, Philadelphia. Parcels directed as 
above, and (carriage paid) under cover, to John Miller, Henrietta Street, Covent Gar- 
den, London; or to John Wiley or G. P. Putnam, J^ew TorJc; or W. D. Ticknor, Bos- 
ton; or M. Hector Bossange, Lib. quai Voltaire, No. 11, Paris, will reach us safely 
and without delay. We particularly request the attention of our foreign correspond- 
ents to the above, as we are often subjected to unnecessary expense for postage and 
carriage. 

All remittances of money, and letters on the business of the Journal, should be ad- 
dressed exclusively to the publishers, Messrs. Blanchard & Lea. 

Jg^^ The advertisement-sheet belongs to the business department of the Journal, 
and all communications for it should be made to the publishers. 



CONTENTS 

OF THE 

AMERICAN JOURNAL 

OF THE 

MEDICAL SCIENCES. 
NO. LY. NEW SERIES. 
JULY, 1854. 



ORiaiNAL COMMUNICATIONS. 
MEMOIRS AND CASES. 

ART. PAGE 

I. Statistical Account of the Cases of Amputation performed at the Penn- 
sylvania Hospital from January 1, 1840, to January 1, 1850. By George 

W. Norris, M. D., Surgeon to the Hospital. 13 

II. On the Climate and Salubrity of Fort Moultrie and Sullivan's Island, 
Charleston Harbour, S. C, with Incidental Remarks on the Yellow Fever 
of the City of Charleston. By John B. Porter, M.D., Surgeon, U. S. 
Army. 21 

III. On the Movements of the Glottis in Respiration. By John C. Dalton, 
Jr., M. D. New York. (With two wood-cuts.) 75 

lY. Extracts from the Records of the Boston Society for Medical Improve- 
ment. By Wm. W Morland, M. D., Secretary. 79 

Y. Observations on the Pathology of Cases of Yellow Fever, admitted into 
the Pennsylvania Hospital during the Summer of 1853. By Thomas 
Hewson Bache, M. D. 121 

YI. Case of very extensive Fistula, successfully treated by a New Method. 
By Horatio G. Jameson, Sen., M. D., formerly of Baltimore, Maryland, 
now of Philadelphia. 129 

YII. Cases of False Anchylosis of the Lower Jaw. By C. S. Fenner, M. D., 
of Memphis, Tenn. 131 

YIII. A Case of Hydrometra. By Lewis Shanks, M. D., Professor of Ob- 
stetrics, in the Memphis Medical College. 133 



REYIEWS. 

IX. Human Ovulation and Menstruation. (Beitrage zur Lehre von der 
Menstruation und Befruchtung.) Prof. Dr. Th. L. W. BischofiF. In 
Henle and Pfeufer's Zeitschrift fur rationelle Medecin, lY. (N. S.) Hft. 

i. pp. 129-175. 1853. 137 

X. An Enquiry into the Pathological Importance of Ulceration of the Os 
Uteri. Being the Croonian Lectures for the year 1854. By Charles 
"West, M. D., Fellow of the Royal College of Physicians ; Physician Ac- 
coucheur to St. Bartholomew's Hospital ; and Physician to the Hospital 

for Sick Children, London, 1854. 8vo. pp. 95. - - - - -146 



8 



CONTENTS. 



BIBLIOGEAPHICAL NOTICES. 



ART. 



PAGE 



XI. Clinical Report on Dysentery, based upon an Analysis of Forty-nine 
Cases, with Remarks on the Causation, Pathology, and Management of 
the Disease. By Austin Flint, M. D. Buffalo, 1853— pp. 90. 

Clinical Report on Chronic Pleurisy based on an Analysis of Forty-seven 
Cases. By the same — pp. 58. 

XII. First Annual Report to the General Assembly of Kentucky relating 
to the Registry and Returns of Births, Marriages, and Deaths, from Janu- 



XIII. Lectures on the Diseases of Infancy and Childhood. By Charles 
"West, M. D,, Fellow of the Royal College of Physicians, Physician to the 
Hospital of Sick Children, Physician-Accoucheur to, and Lecturer on 
Midwifery at, Saint Bartholomew's Hospital. Second American from 
the second and enlarged London edition. Philadelphia : Blanchard & 
Lea, 1854. Svo. pp. 486. - - - - - - - - 168 

XIV. The Diseases of the Heart and the Aorta. By "William Stokes, Regius 
Professor of Physic in the University of Dublin, Author of " The Treat- 
ment and Diagnosis of the Diseases of the Chest,'' &c. Philadelphia: 
Lindsay & Blakiston, 1854. Svo. pp. 689. - - . _ - - - - 169 

XV. Practical Observations on Gout and its Complications, and on the 
Treatment of Joints stiffened by Gouty Deposits. By T. Spencer "Wells, 
Fellow of the Royal College of Surgeons of England, Member of the Royal 
Institution of Great Britain, of the Pathological and Epidemiological So- 
cieties, &c., late Assistant Surgeon in Malta Hospital. London: 1854. 
12mo. pp. 288. ^ - - - 174 

XVI. Statistical Reports on the Health of the Navy (British) for the Years 
1837 to 1843, including Seven Years. Part II., East India Station. 
Presented to Parliament, Jun^l, 1853. Folio, 94 pp. - - - - 179 

XVII. History of the Yellow Fever at New Orleans, La., in 1853.^ By E. 
D. Fenner, M.D., one of the Physicians to the New Orleans Charity Hos- 
pital, &c. &c. New York: 1854. Svo. 84 pp. - - - - ^- 184 

XIX. — Woman ; her Diseases and Remedies. A Series of Letters to his 
Class. By Charles D. Meigs, M. D., Professor of Midwifery, and the Dis- 
eases of Women and Children, in the Jefferson Medical College at Phila- 
delphia, &c. &c. Third edition, revised and enlarged. Blanchard & 
Lea, Philadelphia, 1854. Svo. pp. 672. - - 192 

XX. Handbook of Chemistry, Theoretical, Practical, and Technical. By 
F. Abel, Professor of Chemistry at the Royal Military Academy, Wool- 
wich, &c., and C. L. Bloxam, formerly First Assistant of the Royal Col- 
lege of Chemistry, with a Preface by Dr. Hoffmann, and numerous illus- 
trations on wood. Philadelphia: Blanchard & Lea, 1854. Svo. pp. 681. 192 

XXI. Elementary Chemistry, Theoretical and Practical. By George Fownes, 
F. R. S. Edited, with additions, by Robert Bridges, M. D., Professor of 
Chemistry in the Philadelphia College of Pharmacy. A new American 
from the last revised London edition. Philadelphia : Blanchard & Lea, 
1853. 12mo. pp. 555. - - 193 

XXII. Remarks on the Origin of the Yellow Fever which prevailed in Phila- 
delphia, in 1853. R. La Roche, M.D. (Transactions of the College of 
Physicians of Philadelphia, Vol. II. N. S., No. IV.) - - - - 194 

XXIII. The Mastodon Giganteus of North America. By John C. Warren, 
M. D., late Professor of Anatomy in the University of Cambridge; Presi- 
dent of the Boston Society of Natural History; Member of the American 
Philosophical Society; of the American Academy of Arts and Sciences; 
of the Philadelphia Academy of Natural Sciences ; of the Academy of 
Naples and Medical Society of Florence ; Honorary Member of the Medico- 
Chirurgical Society of London ; Corresponding Member of the Academy 
of Medicine of Paris, &c. &c. Boston, 1852. 4to. pp. 219. With twenty- 
seven Plates. 




157 



CONTENTS. 



9 



Address to the Boston Society of Natural History. By John C. Warren, 
M. D., President of the Society. Boston, 1853.* 8vo. pp. 48. 

Remarks on some Fossil Impressions in the Sandstone Rocks of Connecticut 
River. By John C. Warren, M. D., &c. Boston, 1854. 8vo. pp. 54. 
With a Plate. 

The Preservation of Health. With Remarks on Constipation, Old Age, 
and Use of Alcohol in the Preparation of Medicines. By John C. War- 
ren, M. D., &c. &c. Boston, 1854. 8vo. pp. 140. - -"' - - - 208 



QUARTERLY SUMMARY 

OF THE 

IMPROVEMENTS AND DISCOYERIES IN THE 
MEDICAL SCIENCES. 



FOREIGN INTELLIGENCE. 
Anatomy and Physiology. 



PAGE I 

1. Structure of the Spleen. By 
Mr. Huxley. - - - - 207 

2. Vascular Tissue of the Schnei- 
derian Mucous Membrane. By 
Dr. Kohlrausch. - - - 208 

3. Mucous Membrane of the Sto- 
mach. By Ecker. - - - 208 

4. The Anatomy and Surgical Re- 
lations of the Fascia of Scarpa. 

By Mr. J. Struthers. - - 208 

5. The Process of Repair in Teeth. 
ByDr. S. J. A. Salter. - -209 

6. Elasticity of Arteries considered 
as a Cause of Animal Heat. By 
Dr. Winn. - - - - 209 

7. Starch in the Brain. By Mr. 
Busk. 210 

8. On the Relation that Fat bears 
to the Presence of Sugar in the 



PAGE 

Livers of the Mammalia and 
Birds. By Dr. Gibb. - - 211 
9. On the Deposit of Fat in Cer- 
tain Conditions of the Bodies of 
the Lower Animals. By Dr. 
Crisp. 212 

10. Bernard on the Conditions 
under vrhich Certain Substances, 
usually retained in the Blood, 
pass into the Urine. - - - 212 

11. Case of Diarrhoea Adiposa, 
confirmative of Bernard's Vievrs, 
with regard to the Functions of 
the Pancreas. By Mr. Marston, 212 

12. The Effects of the Recumbent 
Position during Syncope, Phy- 
siologically Considered. By Mr. 
Richardson, - 214 



Materia Medica and Pharmacy. 

13. Local Anaesthesia. By Dr. 15. Modes of Exhibiting Cod-liver 
Hardy. 215 Oil. - - - - - - 218 

14. Production of Local Ansesthe- 16. Medicinal Constituents of the 
sia. By Dr. Snow. - - - 217 Lemon. By Dr. Cogswell. - 219 



Medical Pathology and Therapeutics, and Practical Medicine. 

17. Pyrosis, its Causes, Pathology, 18. Treatment of Diabetes. By 

and Treatment. By Dr. George Goolden. 222 

Budd. 221 19. Topical Uses of Iodine. - - 223 



10 



CONTENTS. 



PAGE 

20. Abortive Treatment of Small- 
pox by Zinc Plaster. By Dr. 
John Hughes Bennett. - - 224 

21. Formula for Gouty, Rheumatic, 
and Neuralgic Affections. By 
Dr. Gafford. - - ^. -225 

22. Cotyledon Umbilicus in Epi- 
lepsy. By W. H. Banking, 
M.D. 225 

23. Oxide of Zinc andHyoscyamus 
for arresting Colliquative Sweat- 
ings in Phthisis. By Dr. Theo- 
philus Thompson. - - - 225 

24. On the Influence of Belladonna 
in counteracting the Poisonous 
Effects of Opium. ByDr.Thos. 
Anderson. .... 225 

25. Local Use of Yeratria, espe- 
cially in Scrofulous Affections 
of Joints. By Dr. J. B. Kling- 
ner. - ~ .... 226 

26. Exercise of the Vocal Organs 
in Ulceration of the Larynx. By 

M. Trousseau. - - - - 229 

27. Neuralgic Headache. By J. 
Murphy, M.D. - - - - 229 

28. Hysterical and Spasmodic 
Cough. By Dr. Andrew Wood. 232 



PAGE 

29. Report regarding the Cases of 
Hydrophobia which occurred in ^ 
France during the year 1852. 

By M. Ambroise Tardieu. - 232 

30. Hydrophobia in a Cretin — Re- 
markable Development of the 
Intelligence during the Parox- 
ysms of the Disease. By M. 
Niepce. " . " . - - - 233 

31. Hvdrophobia Five Years after 

the Bite— Death— Autopsy. - 234 

32. Morbid Changes in the Mucous 
Membrane of the Stomach. By 
Dr. Hanfield Jones. - - - 237 

33. Waxy Degeneration. By Dr. 

W. T. Gairdner. _ - - _ - 239 

34. Metastasis, in its Practical 
Bearings. By Mr. Hunt. - 239 

35. Fatal Effects of Imperfect 
Union of the Umbilical Yein 
after Childbirth; Jaundice as 
the Result of the Imperfect Clo- 
sure of the Ductus Yenosus. By 
j\Ir. Henry Lee. . . . 240 

36. Portion of Intestine discharged 
after Intussusception. By Dr. 
Paterson. 241 



Surgical Pathology and Therapeutics, and Operative Surgery. 



37. Phlebitis, especially in Con- 
nection with the Deligation of 
Yeins. By Mr. Weeden Cooke. 241 

38. Popliteal Aneurism ; Long- 
continued Compression — Even- 
tual Solidification of the Sac. 

By Mr. Poland. - - - 243 

39. New Mode of Treating Ulcers 
from Irritation of the Nails. By 
Mr. Ure. 246 

40. Gunshot Wound inflicted by 
the Minie Rifle. By Mr. Tufnel. 246 

41. Dislocations of both Femora at 
the same time in the same Sub- 
ject. By H. L. Prichard, Esq. 247 

42. Dislocation Upwards and Back- 
wards of the Metatarsal Bone of 
the Great Toe alone. By Dr. 

J. H. Power. - - - - 248 

43. Radical Cure of Reducible 
Inguinal Hernia by a New Ope- 
ration. By Spencer Wells. - 249 

44. Abnormal Obturator Artery in 
Femoral Hernia. By Mr. Mac- 
kenzie. 251 



45. Amputation at the Shoulder- 
Joint. By Mr. Alexander Ure. 252 

46. Amputation at the Knee-Joint. 

By H. G. Potter, Esq^. - _ - 253 

47. Excision of the Knee-Joint. 

By Mr. R. J. Mackenzie. - - 254 

48. Dieffenbach's Operation for 
Ununited Fracture. By Mr. 
Mackenzie. - 255 

49. Puncture of the Bladder 
through the Symphysis Pubis. 

By Dr. D. Leasure. - - - 256 

50. Ovariotomy, with reference to 
its Introduction into Legitimate 
Practice. By Mr. G. B. Childs. 257 

51. Treatment of Ovarian Dropsy 
by Injections of Iodine into the 
Cysts'. By Prof. Simpson. - 259 

52. Summary of the Statistics of 
some of the more important Ope- 
rations performed in the princi- 
pal London Hospitals during the 
last six months of 1853. - - 260 



CONTENTS. 



11 



Midwifery. 

PAGE j PAGE 

53. Double Uterus — Twins. Bj during PregnancT — Recovery. 

M. Hohl. 263 I By Dr. Gibson. - - 269 

54. Chloroform in Midwifery. By j 57. On some of the Diseases in- 
S. AV. J. Merriman. - - 263 i eluded under the term " Prolap- 

55. Cases of Hysteria and Spurious i sus Uteri/' their Diagnosis and 
Pregnancy. By Dr. Alexander ^ j Treatment. By Dr. Snow Beck. 271 
Keiller. 265 , 58. Yaginal Cystocele mistaken 

56. Rupture of an Ovarian Cyst i for Prolapsus Uteri — Operation 

—Cure. By Mr. J. B. Brown. 272 

Medical Jurisprudexce axd Toxicology. 

59. Order of Succession in the Pu- ; 62, Recovery after taking a Large 
trefactive Process. Bv Dr. Cas- j Dose of Prussic Acid. By W, 
per. - - - - - 274! H. Burnam. - - -"^ -276 

60. Suicidal Suffocation. - - 275 ' 63. Upon the Legal and Social 

61. Mistaken Personal Identity. j Rights of Malformed Beings. 

By Dr. Kinlock. - - - 275 ; By J. Bierbauaa. - - - 276 

Miscellaneous. 

64. Meteorological Changes in Re- | lation to Epidemic Diseases. By 

1 Dr. Richardson. - - - 277 



AMERICAN IXTELLIGENCE. 
Original Comhuxicatioxs. 

A Case of Labour, in which the Tapeworm expelled by Infusion of 
Rupture of the Membranes, and Pumpkia Seeds. ByD.Leasure, 

Reclosure of the Os Uteri occur- M. D. 281 

red ten hours after its commence- A Remarkable Case of General 
ment. By Joseph Parrish. M.D. 279 \ Emphysema. By E. K. Beaver, 

Hemorrhage from the Bowels in a j M. D. 281 

New-born Infant. Recovery. j 
By W. B. Young, M. D. - - 280 i 

Domestic Summary. 

Yesico-Taginal Fistula of Seven , treated by Iodide of Potassium. 
Years' Duration cured in Thir- : By Dr. J. D. Griscom. - - 286 
teen Davs. Bv Dr. J. Marion ' Cold as an Anossthetic Agent. By 

^ Sims. ' - . - - - 283 I Dr. Thos. Wood. - - - 287 

Yesico-Yaginal Fistula success- | Apparatus for Accommodation of 
fully treated. By Dr. N. Boze- | the Eye to Distinct Yision at 
man. ------ 283 | Different Distances. By Dr. Yon 

Yarieocele successfully treated. j Roth. _ - . . _ 288 
By Dr. Juriah Harriss. - - 284 I Double Monstrosity. By Prof. H. 

Ef&cacy of Cod-liver Oil in Con- i Y. N. Miller. - - - - 289 
sumption. By Prof. Wood. - 285 ' Twins of different Colour. By Dr. 

Lead Diseases treated by the Iodide A. F. Attaway. - - -290 

of Potassium. By Dr. H. S. Report of the Committee on Medi- 
Swift. 286 cal Education to the American 

Membranous Croup successfully ; Medical Association, in 1853. - 290 

1 Note from Dr. La Roche. - - 291 



THE 



AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES 

FOE,JULY185 4. 



Art. I. — Statistical Account of the Cases of Amputation performed at the 
Pennsylvania Hospital from January 1, 1840, to January 1, 1850. By 
George W. Norris, M. D., Surgeon to the Hospital. 

In the Nos. of this Journal for August, 1838, and May, 1840, we gave 
statistical tables of all the capital amputations performed at the Pennsylvania 
Hospital from 1830 to 1839 inclusive, with the view of calling attention to 
the great mortality which followed these operations. At that time, no statisti- 
cal accounts of amputations on a large scale done by individuals, or in hospital 
practice, in this country, were known to me, and only a few loose statements, 
without any detail of particulars, could be had from Europe. The tables 
alluded to attracted some notice, and the profession have since been furnished 
with similar ones from two other American, as well as from several British 
hospitals. The list now given is a continuation of those which I have already 
published, carried down for another ten years, viz: to January 1, 1850, and 
is drawn up in a manner similar to them, with a summary appended of the 
twenty years' experience of our Institution, together with a comparison of 
the general results from those American hospitals which have published ma- 
terials for it. 

In these tables, all amputations in which the operation was performed 
within twenty-four hours after the occurrence of the accident are included 
under the head of immediate, and the cases treated of this class were generally 
of the most desperate kind, resulting from railroad accidents, machinery, 
&c., where the soft parts were as seriously injured as the bones. 



No. LY.— July 1854. 2 



14 Norris, Statistics of Amputations at Pennsylvania Hospital. [July 



No. 


Date. 


Name. 


6 
< 




1840 






1 


May 12 


James Bass 


24 ( 


2 


Sent 20 


TTpTiTv SfiiInT 


41 ( 




1841 






3 


Jan. 16 


Peter Hart 


39 


4 


May 13 


John Resor 


22 ( 


5 


June 16 


David Reeside 


38 


6 


June 28 


William Dern 


31 


7 


July 21 


Redman Fellow 


45 


8 


Aug. 22 


Patrick Hughes' 


40 


9 


Sept. 23 


John M enough 


46 


10 


Sept. 26 


Samuel Gilfrey 


26 


11 


Oct. 6 


Lewis Jones 


16 


12 


Dec. 27 


George McLaughlin 


31 


13 


Dec. 31 


W^illiam Fisher 


38 




1842 






14 


Jan. 19 


James McMullin 


60 


15 


March 15 


John Slack 


27 


16 


March 25 


Hugh Bennet 


37 


17 


June 27 


Patrick Scanlin 


21 


18 


July 1 


Henry Smith 


10 


19 


Aug. 10 


John Kane 


28 


20 


Aug. 16 


William Eason 


33 


21 


July 31 


George AViley 


35 


22 


Sept. 2 


Charles Vise 


13 


23 


Sept. 23 


Philip Bouvier 


38 


24 


Oct. 29 


Philip Riley 


25 


25 


Nov. 30 


John Smith 


31 




1843 






26 


April 18 


Miller Brown 




27 


July 22 


William Wright 


46 


28 


Ano" 4 


W^illiam Hardy 


10 


29 


Sept. 17 


Henry Gray 


18 




1844 






30 


Feb. 18 


Owen Tighe 


25 


31 


Feb. 22 


John Brown 


7 


32 


Feb. 22 


William Latham 


22 


33 


March 15 


John Matthews 


42 


34 


Jan. 17 


John McNamee 


39 


35 


June 8 


William Smith 


5 


36 


July 8 


James Crawford 


18 


37 


July 31 


Charles Campbell 


23 


38 


July 27 


Caspar Albert 


1] 


39 


Aug. 10 


David Graham 


13 


40 


Sept. 11 


Edward McHugh 


15 


41 


Aug. 24 


Joseph Wolf 


4(J 


42 


Sept. 7 


Martin Ulrick 


12 


43 


Oct. 11 


John Gordon 


12 


44 


Oct. 12 


Elihu Foster 


36 


45 


Oct. 7 


Thomas Murphy 


52 


46 


Dec. 6 


Henry Darnell 


16 


47 


Dec. 11 


Hugh McCarty 


10 




1845 






48 


Jan. 16 


Jeremiah Cummey 


9 


49 


May 20 


ATilp«5 ftriffin 

i>JLil*:?o VJllIJLlli 


16 


50 






25 


51 


Mav 28 




26 


52 


Nov. 17 


Michael Curwein 


16 


53 


Sept. 20 


Daniel Cliff 


27 


54 


Dec. 6 


John Kline 


22 




1846 






55 


.Jan. 31 


Henry Trite 


25 


56 


Feb. 3 


John McAnall 


26 



Disease or injury. 



Lacerated arm 



Amputated leg 



Lacerated and Fractured leg and foot 
Compound and comminuted fracture of legs 

Deformity of foot 

Compound and comminuted fracture of leg 
Forearm torn off, and humerus fractured 
Forearm torn off, and lacerated and fractured arm 
Compound and comminuted fracture of leg 
Compound and comminuted fracture of leg 
Mashed foot 

Compound fracture of leg 
Forearm torn off 
Gunshot wound of hand 
Compound and comminuted fracture of leg 
Compound and comminuted fracture of legs 

Caries of elbow 

Compound fracture of forearm, and laceration 
Comminuted fracture of hand 
Gunshot wound of wrist and hand 

Compound and comminuted fracture of legs 
Compound and comminuted fracture of leg 
Compound fracture and laceration of hand 
Comp. fract. and lacer. of wrist and forearm 
Tumour on the leg 
Fracture and laceration of foot 
Gunshot fracture of head of humerus 
Compound fracture of leg 
Compound fracture of foot and hand 
Compound fracture of thigh 
Deformed and ulcerated leg 
Sloughing after fracture of astragalus 
Compound fracture of forearm 
Compound fracture and laceration of foot 
Laceration from bursting of a gun 
Compound fracture of foot 
Compound fracture of arm 
Compound fracture of hand 

Compound fracture of knee-joint 
Fracture and wound of hand from a gun 
Compound fracture of leg 
Compound fracture of leg 
Arm torn off, and severe contusion of body 
Lacerated hand and wrist 
Caries of knee-joint 

Lacerated hand and forearm from a gun 
Compound fracture of elbow, and dislocation of 
humerus of same side 



1 The limb was amputated in consequence of an injury, three days before admission, at Havre de Grace. 



1854.] Norris, Statistics of Amputations at Pennsylvania Hospital. 15 



Part amputated. 


Immediate or 
otherwise. 


Result. 


Period of discharge 
or death. 


Date of amputation. 


















1840 


, 1840. 


Leg 


Immediate 


Died 


May 13 




Leg 




do. 


September 27 
1841 


September 23. 
1841. 


Arm 


do. 


Cured 


March 11 




Thigh 




do. 


September 7 


May 29. 


Leg 


do. 


Difed 


June 20 




Leg 
Leg 


do. 


do. 


July 1 




do. 


do. 


August 5 
February 19 




Leg 


do. 


Cured 




Leg 


do. 


Died 


September 26 
October 28 




Forearm 


do. 


Cured 




Forearm 


do. 


do. 


October 27 




Leg 
Legs 


do. 


do. 


January 29, 1842 




do. 


do. 


February 25, 1842 








1842 


1842. 


Leg 




do. 


September 27 


January 23. 


Leg 


do. 


do. 


June 30 




Forearm 


do. 


do. 


May 18 




Shoulder-joint 


do. 


do. 


October 5 




Leg 


do. 


do. 


August 10 




Leg 


do. 


Died 


August 14 




Leg 




do. 


September 1 




Thigh 




Cured 


November 5 


August 31. 


Arm 


do. 


do. 


November 2 




Forearm 


do. 


do. 


October 29 




Leg 


do. 


do. 


March 18 




LegS' 


do. 


Died 


December 3 








1843 


1843. ' 


Arm 




Cured 


September 13 


July 19. 


Arm 


do. 


do. 


September 16 




Forearm 


do. 


do. 


October 28 




Forearm 


do. 


do. 


October 28 
1844 


1844. 


Leg 




Died 


February 24 


February 19. 


Thigh 


do. 


Cured 


March 22 




Hand (partial) 


do. 


do. 


April 27 




Forearm 


do. 


do. 


May 15 




Leg 




do. 


June 24 


April 6. 


Leg 


do. 


do. 


August 7 




Shoulder-joint 


do. 


do. 


August 20 




Leg 




do. 


November 6 


August 7. 


Foot (partial") 




Died 


August 10 


August 7. 


Thigh 


do. 


do. 


August 11 




Knee-joint 




Cured 


March 1 


September 17. 


Leg 




do. 


December 2 


September 19. 


Forearm 




do. 


November 30 


October 9. 


Foot (partial) 




do. 


March 14 


October 12. 


Forearm 


do. 


do. 


November 11 




Leg 




Died 


October 19 


October 16. 


Arm 


do. 


Cured 


February 7 




Forearm 


do. 


do. 


January 25 
1845 


1845. 


Thigh 


do. 


Cured 


June 29 




Forearm 




do. 


June 28 


June 4. 


Leg 


do. 


Died 


July 6 




Leg 




Cured 


July 23 


June 21. 


Arm 


do. 


Died 


November 18 




Forearm 


do. 


Cured 


December 8 




Thigh 




do. 


March 7 
1846 


December 31. 
1846. 


Forearm 


do. 


Cured 


April 24 




Arm 


do. 


do. 


April 22 





16 



NorriSj Statistics of Amp 



utations at Pennsylvania Hospital. [July 



No. 



57 

58 
59 
60 
61 
62 
63 
64 
65 
66 
67 

68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 
86 
87 



Date. 



100 
101 
102 
103 
104 
105 
f06 

107 
108 
109 
110 
111 
112 
113 
114 
115 
116 
117 



Jan. 26 

April 6 
•June 10 
June 23 
July 8 
July 8 
July 23 
Aug. 28 
Oct. 2 
Oct. 22 
Dec. 31 

1847 
March 25 
April 13 
April 16 
May 4 
May 10 
May il 
April 27 
Feb. 14 
June 19 
June 21 
June 25 
Aug. 3 
Aug. 15 
Aug. 24 
Sept. 11 
Oct. 22 
Sept. 25 
Nov. 5 
Dec. 7 
Dec. 6 
May 5 
Nov. 27 
Nov. 5 
Dec. 25 
Dec. 27 

1848 
Jan. 17 
Jan. 17 
Feb. 21 
May 3 
Feb. 16 
May 23 
June 23 
June 28 
Aug. 1 
Sept. 21 
Nov. 9 
March 30 
Nov. 30 
Dec. 16 

1849 
Jan. 10 
Jan. 26 
March 4 
April 17 

May 11 
Aug. 4 
Sept. 1 
Sept. 27 
Sept. 22 
Dec. 8 



Name. 



James Appleton 

William Logue 
Jesse Workwell 
Alexander Murray 
John Glendinning 
David Fitz Simmons 
David Jones 
Jacob Young 
James McCormack 
Edmund Wheeler 
David Eikins 

John Masterson 
William Riggles 
John Magee 
John Campbell 
Thomas Higgins 
Thomas Dickerson 
Mary Goodwin 
William W. Pelham 
James Love 
Daniel Holt 
James Caldwell 
George Myers 
John Sloan 
James Leamy 
Isaac Willis 
Nero Purnsley , 
Jeremiah Brew 
Thomas Fry 
John Kirks 
John Quigley 
Margaret Rafferty 
William Walz 
James C. Riley 
Thomas Downs 
Charles Lun 

Amos Kelly 
John Sheilds 
George Ludwig 
James Lithgow 
Edward McGregor 
Robert Simpson 
Benjamin Murphy 
Henry McGuigan 
William ConneU 
Martha Lister 
Thomas Donahue 
Isabella Ford 
James Nealis 
John Ziegler 

John Magaw 
Matthew Hay 
Sarah McQuade 
Edward Pratt 
Charles Barker 
Matthew D. Neal 
Jacob Bachman 
Yemens Silverthorn 
Martin Low 
John McGlover 
Josiah Lewis 



41 



Disease or injury. 



Simple fracture of thigh, followed by dry gan- 
grene of foot 
Ulceration from burn, and necrosis of hiimerus 
Fractured and lacerated hand 
Lacerated hand from a circular saw 
Compound and comminuted fracture of leg 
Forearm torn olf 
Lacerated and fractured forearm 
Compound and comminuted fracture of leg 
Compound and comminuted fracture of leg- 
Compound fracture of leg 
Gunshot wound of hand 

Compound fracture and laceration of feet 
Compound fracture of leg 
Comminuted fracture of foot 
Compound fracture of leg and foot 
Compound fracture of leg 
Fracture and laceration of wrist and hand 
Tumour on leg 
Caries of ankle-joint 
Caries of foot 

Compound fracture and laceration of forearm 

Compound fracture of leg 

Compound fracture of arm 

Compound fracture of leg 

Fracture and laceration of hand 

Compound fracture of ankle 

Compound and comminuted fracture of leg 

Compound fracture of leg 

Gunshot wound of wrist-joint 

Compound and comminuted fracture of elbow 

Compound fracture of leg 

Caries of ankle and foot 

Hemorrhage after compound fracture of forearm 
Caries of knee-joint 

Compound fracture of wrist from bursting a gun 
Caries of wrist-joint 

Arm torn off by machinery 

Gunshot wound of wrist and hand 

Compound and comminuted fracture of arm 

Wound from circular saw 

Caries of knee-joint 

Lacerated and fractured arm 

Comminuted and lacer. arm, and fractured thigh 

Comp. fract. and laceration of arm and forearm 

Compound and comminuted fracture of forearm 

Caries of knee-joint 

Lacerated and fractured hand and wrist 
Ununited fracture of thigh 
Compound and comminuted fracture of leg 
Compound and comminuted fracture of foot 



9 Comp. fract. of leg, and fract. arm and forearm 
49 Burned hand 



Burned forearm and arm 
Tumour on the leg 
Caries of the knee 

Comminuted fracture and laceration of hand 
Compound fracture and dislocation of elbow 
Compound fract. of forearm and arm, and of lej 
Compound fracture of foot 
Caries of ankle following compound fracture 
Compound and comminuted fracture of leg 



1854.] Norris, Statistics of Amputations at Pennsylvania Hospital. 17 



Part amputated. 


Immediate or 


Resiilt. 


1 Period of discharge 


Date of amputation. 




otherwise. 




or death. 


T „~ 

Leg 




Cured 


May 30 


March 26. 


Arm 




Died 


May 28 


April 15. 


Hand (partial) 


Immediate 


Cured 


July 18 




Hand (partial) 


do. 


do. 


August 6 


i 


Leg 


do. 


do. 


September 5 




Arm 


do. 


do. 


September 16 




Arm 


do. 


do-. 


October 7 




Leg 


do. 


Died 


October 4 




Inigh. 


do. 


do. 


October 15 




Leg 




do. 


October 27 




Forearm 


do. 


Cured 


February 10 


- 








1847 


1847. 


ieet (partial) 


do. 


do. 


July 1 




Leg 


do. 


do. 


August 18 




Leg 


do. 


Died 


April 30 




Leg 


do. 


Cured 


July 1 




Leg 


do. 


Died 


May 12 




Forearm 


do. 


Cured 


June 17 




Thigh 




do. 


September 9 


May 15. 


Leg 




do. 


June 16 


May 15. 


Foot (partial) 




do. 


July 29 


June 20. 


Forearm 


do. 


do. 


July 21 




Leg 


do. 


do. 


September 18 




Arm 


do. 


do. 


September 18 




Leg 


do. 


^ do. 


October 23 




Hand (partial) 


do. 


do. 


October 9 


1 


Leg 




do. 


November 16 


September 29. 


Leg 




Died 


November 10 


October 23. 


Thigh 




Cured 


February 21 


October 30. 


Forearm 


do. 


do. 


November 18 




Arm 


do. 


do. 


February 2 




Leg 




Died 


December 28 


December 11. 


Leg 




Cured 


April 1 , 1848 


December 15. 


Arm 




Died 


December 26 


December 16. 


Thigh 




Cvu*ed 


April 1, 1848 


December 22. 


Forearm 


do. 


do. 


February 23 




Forearm 




do. 


February 23, 1848 


January 5, 1848. 








1848 


1848. 


Arm 


do. 


do. 


April 22 




Forearm 


do. 


do. 


March 10 




Arm 


do. 


do. 


May 12 




Forearm 


do. 


do. 


June 23 




Thigh 




do. 


August 23 


May 13. 


Shoulder-joint 


do. 


do. 


July 22 




Arm 


do. 


do. 


October 9 




Shoulder-joint 


do. 


do. 


August 25 




Arm 


do. 


do. 


September 29 




Thigh 




do. 


November 18 


October 4. 


Forearm 


do. 


do. 


February 4 


1 


Thigh 




do. 


January 1 


November 15. 


Thigh 


do. 


do. 


February 3 


! 


Leg 


do. 


Died 


December 21 


J 






1849 


1849. 1 


Thigh 




Cured 


April 1 


January 20. i 


Forearm 


do. 


do. 


June 25 




Ai'm 




do. 


May 14 


March 7. 


Leg 




do. 


April 21. 


Thigh 




do. 


August 22 


April 28. 


Forearm 


do. 


do. 


July 12 




Arm 


do. 


do. 


September 6 




Arm 


do. 


do. 


October 13 




Foot (partial) 


do. 


do. 


November 20 




Leg 




do. 


December 1 


October 17. 


Leg 


do. 


Died 


December 11 





18 Norrisj Statistics of Amputations at Pennsylvania Hospital. [July 

From the above Table it appears that from January, 1840, to January, 
1850, there were 120 capital amputations performed on 117 patients. Of 
these, 16 were of the thigh, 45 of the leg, 1 at the knee, 6 at the feet, 4 at 
the shoulder-joint, 20 of the arm, 24 of the forearm, and 4 of the hand. 

Eighty of the 120 operations were primary, being done for recent injuries 
within twenty-four hours after the occurrence of the accident, and of these, 
63 were cured, and 17 died. 

Twenty-one were secondary, of which 12 were cured, and 9 died. 

Nineteen were for the cure of chronic affections, of which 18 were cured, 
and 1 died. 

Fourteen of the whole number in the Table were done at the joints, of 
which 13 were cured, and 1 died. 

Fifty-two of the amputations were of the upper extremity, of which 49 
were cured, and 3 died. 

Sixty-eight were of the lower extremity, of which 42 were cured, and 23 
died. 

A general summary of the Tables now furnished, and of those heretofore 
published in the Nos. of this Journal, already referred to for the ten years 
from 1830 to 1840, gives the following results: — 

Of 200 amputations upon 196 patients, performed during the 20 years 
from 1830 to 1850, 148 were cured, and 48' died. 

Of these, 115 were primary, of which 27 died. 
" 41 were secondary, of which 16 died. 

44 were for the cure of chronic diseases, of which 5 died. 

Eighty-four of the amputations were of the upper extremity, of which 8 
died. 

One hundred and twelve were of the lower extremity, of which 39 died. 

Twenty-one were amputations at the joints, of which 4 died. 

Forty-nine of the 196 patients operated on, were under 20 years of age, 
of whom 45 were cured, and 4 died. 

Fifty-six were between 20 and 30, of whom 45 were cured, and 11 died. 

Forty-seven were between 30 and 40, of whom 29 were cured, and 18 died. 

Thirty-seven were between 40 and 50, of whom 24 were cured, and 13 
died. 

Five were upward of 50, of whom 4 were cured, and 1 died. 
The age of two was not noted ; they were both adults, 

Summary of the published Tables of the amputations performed in the 
Pennsylvania, Massachusetts General, and New York City Hospitals : — 



1854.] Norris, Statistics of Amputations at Pennsylvania Hospital. 19 

No. of Amputations. Cured. Died. 

Pennsylvania Hospital' (Jan. 1830 to Jan. 1850) 200 on 196 patients 148 48 

Mass. Gen. Hospital2 (.Jan. 1822 to Jan. 1850) 146 on 141 " 109 32 

N. Y. City Hospital^ (Jan. 1839 to April 1851) 154 100 54 

500 on 491 " 357 134 

The following Table exhibits the mortality after operations upon the upper 
and lower extremities in the three Institutions mentioned : — 

1. Upper Extremity. 





No. of Amputations. 


Cured. 


Died. 


Pennsylvania Hospital 


84 


76 


8 


Massachusetts General Hospital 


22 


19 


3 


N. Y. Hospital 


56 


43 


13 




.162 


138 


24 


2. Lower 


Extremity. 








No. of Amputations. 


Cured. 


Died. 


Pennsylvania Hospital 


. 112 


73 


39 


Mass. Gen. Hospital 


. 119 


90 


29 


N. Y. Hospital .... 


. 100 


59 


41 




331 


222 


109 



The following shows the mortality after amputations, when done for the 
cure of chronic diseases and injuries, in the same Hospitals : — 

1. Chronic Diseases. 





No. of Amputations. 


Cured. 


Died. 


Pennsylvania Hospital 


44 


39 


5 


Mass. Gen. Hospital 


85 


74 


10 


N. Y. Hospital 


50 


37 


13 




179 


150 


28 




2. Injuries. 








No. of Amputations. 


Cured. 


Died. 


Pennsylvania Hospital 


153 


110 


43 


Mass. Gen. Hospital 


56 


34 


22 


N. Y. Hospital 


104 


63 


41 




313 


207 


106 



No anaesthetic agent was inhaled in any of the cases included in the above 
Tables from the Pennsylvania Hospital. In many of those treated at the 
Boston and New York Institutions, these agents were employed. 

The effect of anaesthetics upon the mortality, after surgical operations, is a 
matter of much interest, to which sufficient attention has not yet been given, 

^ Norris, Amer. Journ, of the Med. Sci. vols. xxii. and xxvi., 1838 and 1840. 

2 Hayward, Amer. Journ. of Med. Sci. vols. xxvi. and xxi. N. S., 1840 and 1851. 

3 Buel, Amer. Journ. of Med. Sci. vol. xvi. N. S., 1848, and Lente, Trans, of Amer. 
Med. Assoc. vol. iv. Philad., 1851. 



20 Norris, Statistics of Amputations at Pennsylvania Hospital. [July 

and it is desirable for this purpose that the results of operations done on a 
large scale, with and without them, should be furnished. Dr. Lente, in his 
Report from the New York Hospital, has noticed the greater mortality after 
amputations in the series of cases collected by him (1848 to 1851), than in. 
those furnished from the same Institution by the previous reporter, Dr. Buel 
(1839 to 1848). The Tables of the former giving 39.68 per cent., while 
those of the latter show only 28.57 — a great difference in favour of the latter. 
To explain it, he remarks : TVe have coincidences of fatality, when almost 
all our operations will prove fatal in spite of us, and coincidences of success, 
when the most desperate cases will recover, and few or none die. We have 
coincidences of certain accidents, and often those reputed the most rare, will 
happen, one after another in quick succession, and so through all the branches 
of surgery. Therefore the difference in mortality might be attributed to the 
occurrence of one of these coincidences; and we may look for an unusual 
success during the next two or three years." Immediately afterwards, he 
adds : ^^Anaesthetics came into general use about the period of the commence- 
ment of these statistics. May not the employment of these have had its in- 
fluence upon the mortality ? We do not deny that it may have had some in- 
fluence in augmenting the fatality of operations, but we have seen no reason 
to infer that it has, except, perhaps, the fact that union hy adhesion seems to 
have been much less frequent since the introduction of anaesthetics into this 
hospital than before. 

The last Table of Dr. Hayward, too, seems rather adverse to the use of 
anassthetics in amputations, since of 52 successive operations in which they 
were employed, 13 died, or 1 in 4; while of the 22 immediately preceding to 
whom they were not administered, only 4 died, or 1 in 5 J. It must be re- 
marked, however, that Dr. Hayward does not himself think that inhalation 
had anything to do with their increased mortality, for in speaking of it, he 
says : "It may not be amiss to add that no fatal effects have followed their 
administration, nor has any serious ill consequence in a single instance ensued 
from it." 



1854.] Horter, Climate^ etc., of Fort Moultrie and Sullivan's Island. 21 



Art. II. — On the Climate and Salubrity of Fort Moidtrie and Sullivan's 
Island, Cliarleston Harbour, S. C, with Incidental RemarJcs on the Yellow 
Fever of the City of Charleston. By John B. Porter, M. D., Surgeon, 
U. S. Army. 

The substance of the following observations is taken from a Special Ke- 
port to the Surgeon-General of the Army, dated March Sll, 1854. 

In large cities it is often difficult to trace the origin of disease ; but this 
is not the case in small places, where the movements of every person can be 
easily ascertained. This is especially the fact in relation to the yellow fever 
of 1852, on Sullivan's Island and at Fort Moultrie, the movements of every 
person, particularly if attached to the garrison in any capacity whatever, being 
easily traced at the commencement of the epidemic, as wejl as both previously 
and subsequently. 

Sullivan's Island is situated in what geologists term the Charleston basin; 
and we will here quote sufficient for the purpose of illustrating the medical 
topography of the island and'vicinity, from the instructive paper of Dr. Ged- 
dings on the medical topography of South Carolina. 

*'In physical aspect, as well as in the essential elements of the soil, a wide 
difference exists between the lower and upper regions of the State. In the 
former, the country is, for the most part, flat, and as the streams have but little 
fall, rendering drainage difficult, the earth is generally surcharged with water 
to within a few feet of the surface, and at many points extensive bay-galls or 
ponds exist, which, in rainy seasons especially, are completely filled with water, 
and often remain so for several months in the year ; but in periods of drought, 
they, as well as many of the. streams fed by them, become completely dry. * 

* * The swamps, or marshes, within the limits of salt water (and the same 
is true of the margin of the ocean generallj^), consists of a profound bed of blue 
mud, containing a large amount of vegetable matter, and generally covered by 
a luxuriant growth of marsh sedge [Spartina glabra). Immense tracts of this 
kind exist throughout this entire region of country, which in many places 
present vast level, prairie-like plains, as far as the eye can see, nearly the whole 
of which are overflowed by high tides. ^, ^ * Examined in its totality, in 
relation to its geological character. South Carolina may be divided into two 
parts of nearly equal extent. The first, comprising all the lower part of the 
State, and extending from the shores of the ocean to a distance of a hundred, 
or a hundred and twenty miles into the interior, belongs exclusively to the 
tertiary formation, in which all the essential features of the several divisions 
of that geological epoch are found more or less strikingly characterized at 
different points. 

" To enter into a minute description of the relative position and extent of 
these formations belonging to the tertiary period, would be of little interest in 
a medico-topographical point of view. It may be remarked that the fossiliferous 
beds, composing the different formations of the tertiary, have interposed be- 
tween them variable layers of sand, mud, and, in many places, clay, which 
give them great irregularity, and often render it difficult to trace their precise 
limits. * * * The sand-beds of the buhrstone are intermingled with those 
of the pliocene, which pass into the superincumbent beds of the pliocene, and 
the latter are, in turn, blended with the moving sands of the coast. The cre- 
taceous formation is found underlying the tertiary, and while all these overlap 
the granite, at the boundary line above alluded to, as forming the limit between 
the tertiary and primitive regions of the State, we find the calcareous beds ex- 



\ 



22 Porter, Climate^ etc.j of Fort Moultrie and SuUivan's Island. [July 



tending from the line of the buhrstone towards the ocean, forming an immense 
deposit of several hundred feet in thickness, constituting what Prof. Tuomy 
has designated the Charleston basin, which he supposes to extend over an area 
of seventy-five miles in length, by sixty in breadth. A great portion of this 
peculiar formation is composed of an immense bed of marl, intermixed with 
fossil shells, and various other organic remains. It underlays the city of 
Charleston, and extends out into the ocean, and is found near the coast, at 
variable depths below the surface, generally from forty to sixty feet. It has 
been perforated by the borings of the artesian well, now in progress in the 
city, and is there several hundred feet in thickness. 

" The leading characteristics of the sea-coast, with its numerous islands, 
inlets, and estuaries, have been already alluded to in our general remarks on 
the physical features of the State, In a geological point of view, however, the 
margin of the ocean presents some notable peculiarities which deserve a passing 
remark. In general terms, it may be remarked that so far as the superficies is 
concerned, the whole of this region consists, for the most part, of vast areas of 
light, fine sand, marsh-mud, and occasionally of clay to a limited extent, super- 
imposed upon the post pliocene beds; the latter, in many situations being ex- 
posed, or very near the surface. This is the most general character, not only 
of the numerous islands, but likewise of the principal part of the main land 
bordering immediately upon the ocean. In consequence of these characters and 
formations, exposed as they are to an influence exercised upon them by the nu- 
merous rivers emptying into the ocean, on the one hand, and to, perhaps, a still 
greater modifying agency from the winds and tides, on the other, are more 
liable than any other geological formations in the State, to great and sudden 
changes of form and general arrangement.^' 

Sullivan's Island is situated on the north side of the small bay which forms 
Charleston Harbour, making a part of it ; the west end or cove being between 
four and five miles from the City of Charleston, and extending to the east 
about three miles, being from one-quarter of a mile to one and a half or two 
miles in breadth. It is a sand island, and is but slightly elevated above the 
level of the sea, severe storms having^ been known to carry the waves over it 
so as almost to submerge it. Boats have been rowed from Fort Moultrie 
down Middle Street, within a recent period, and the residents of the island 
were obliged to repair to the fort for shelter. After the general medical to- 
pography of the low country by Dr. G-eddings, as quoted, that of Sullivan's 
Island, sufficient for all practical purposes to the physician, is soon given : sand 
on the surface, and black sand or mud below this. In dry seasons, water is 
found from a few inches to two or three feet beneath the surface ; and in wet 
seasons, the whole island, except the hills of sand-drift, seems to be nearly 
under water. From the main land on the north the island is separated by a 
channel about three-quarters of a mile wide at high tide, which is nearly ford- 
able at low water. 

Fort Moultrie is on the south side of the island, on the main channel or 
entrance into Charleston harbour, being nearly one mile from the cove, and 
between five and six miles from the city. Charleston (St. Michael's Church) 
is in lat. 32° 46' 33" N. ; long. 79° 55' 38" W. By the observations of the 
Coast Survey, Fort Moultrie is in lat. 32* 45' 31" N.; long. 79° 51' 15" W. 
The fort is surrounded on three sides by the village of Moultrieville. 

"To prove that yellow fever can be imported into a place, I should take an 
island in the middle of the ocean ; I would surround it with other islands pos- 



1854,] Porter, Climate^ etc.^ of Fort 3Ioultrie and Sullivan's Island. 23 



sessing the same characteristies of climate and soil, and peopled by the same 
race. I would have this island healthy for at least fifty years. Then I would 
have arrive at it a ship scourged with yellow fever; this ship should implore 
succor, and it should be granted; yet, as a wise precaution, some kind of 
quarantine should be established. Of all the inhabitants of the island, some 
few only should be brought into the immediate presence of the sick. Within 
the period fixed by experience as the stage of incubation of this disease, one or 
two of these few, and these only,, should begin to sufi'er from the same disease; 
then from these sufierers the disease should gradually spread as from a centre, 
until the whole island was infected. While, however, this one island was thus 
ravaged, the adjoining islands which the infected vessel had not visited should 
remain perfectly free, in order to prove that there was no (so styled) epidemic 
constitution. Then, if all these conditions were fulfilled, I would confess that 
yellow fever may be contagious, and can be imported.^' — Brit, and For. Med.- 
Chir. Rev. Oct. i852, p. 215. 

The same Keview vouches the truth of the foregoing supposed circumstances 
at Boa Yista, even to the health " for at least fifty years," for " no epidemic 
has ever been recorded until this." If Boa Vista, situated within the tropics, 
in lat. 16° 5' N., has been without an epidemic fever for fifty years, until the 
arrival of the Eclair, Sullivan's Island, more than 32° N. of the equator, 
and more than 90° N. of the Tropic of Cancer, must be still more salubrious, 
for, "no epidemic has ever been recorded;" and there has been so much said 
about its salubrity ; its health is annually announced with such a flourish of 
trumpets by the Charleston newspapers and their correspondents; and the 
Army Medical Statistics have been so often invoked in its favour ; that, for 
all epidemics, in all time, some arrival from Castle Pinckney or Charleston, 
some Bann or Eclair, will surely be found to convey the "germ of con- 
tagion" to this favoured spot, which, left to itself, would have never known 
disease or death. A brief medical history of Sullivan's Island, previous to the 
epidemic yellow fever of 1852, may not be unacceptable. 

There are three classes of advocates for the salubrity of this island, viz : 
1. Those who assert that no disease can originate here. 2. Those who 
assert that no fever can originate. 3. Those who assert that yellow fever 
cannot possibly originate. We shall see. 

Dr. B. B. Strobel, of Charleston, a strong advocate for the transmissihiliiy 
of yellow fever — in other words, a strong coutagionist — gives the following • 
account in his Essay : — 

" Sullivan's Island is a mere sand-bank free from ponds, marshes, and vege- 
tation, constantly exposed to the refreshing breezes of the sea, and resorted to 
by strangers and persons of leisure as a delightful retreat from the noise and 
bustle of the city. Now, according to the reasoning of our adversaries, it is im- 
possible that yellow fever can be generated there from local causes. Yet in- 
stances are on record of its having prevailed there epidemically in 1817, and 
if we mistake not in 1838-39.^ Be this as it may, we cannot be mistaken as 
to the occurrences of 1817, for we distinctly recollect that an attempt was then 
made to attribute the fever to some local cause, such as a gutter, or a small 
pond. The yellow fever had not prevailed in Charleston from the year 1807 up 

^ We are permitted to cite one case, that of a young lady who came from the coun- 
try, and proceeded to Sullivan's Island before the fever prevailed in Charleston. She 
took the fever and was very ill. 



24 Porterj Climate^ etc. ^ of Fort Moultrie and Sullivan^ s Mand. [July 

to this time, a period of ten years. Upon the revival of commerce, however, at 
the close of the vrar of 1812, a sudden irruption of yellovp fever took place, at a 
time when the city was filled with strangers. Sullivan's Island was then con- 
sidered as a safe retreat from the fever, and a very large number of ^persons 
went there in hopes to avoid it — many of them were in indigent circumstances, 
and of course crowded together in narrow, confined apartments. Under these 
circumstances the fever was transmitted from Charleston to that place, and 
many persons died of it." Pp. 200, 201. 

Under these circumstances,'^ that is, the presence of persons in " indigent 
circumstances/' and these persons "crowded together in narrow, confined 
apartments/' " the fever was transmitted from Charleston'' These persons 
were in the worst possible situation, in a state of fear and anxiety, in nar- 
row and confined apartments, crowded together in hot weather, and in a 
filthy condition ; for poverty and filth, somehow or other, are almost inse- 
parable. Indeed, crowded together in this way, it would be nearly impossible 
for a better class of people to keep themselves comfortable or decent. We 
have here the efficient causes of malignant fever, which, in the colder climate 
of the northern States, or Ireland, would produce typhoid or typhus fever, 
and which, in the meridian of Sullivan's Island did, in my opinion, produce 
yellow fever. 

Again, in 1817, Dr. Strobel says: — 

" Many persons arriving in our harbour, and learning the condition of the 
city, proceeded from the vessels immediately to the island, where they sickened 
and died." P. 201. 

Certainly, these persons could not have transmitted the fever from Charles- 
ton to the Island, for they were never in the city, but proceeded directly from 
the vessels as soon as they arrrived in the harbour. How came they to sicken 
and die of yellow fever on Sullivan's Island ? 

The young lady from the country, spoken of by Dr. Strobel, could not have 
transmitted the disease from Charleston, in 1839, for she proceeded to Sulli- 
van's Island before the fever prevailed in Charleston. On Sullivan's Island 
" she took the fever and was very ill." Dr. Lobby stated to me recently that 
several cases of severe fever occurred in 1839, back of Fort Moultrie, among 
^ females who had not left the Island since April. "We shall recur to the fevers 
of this year again. 

It appears, then, that the first yellow fever of Sullivan's Island on record 
occurred in 1817, and, from the evidence supplied by Dr. Strobel himself, I 
have little hesitation in saying that the disease originated there. 

In 1824, yellow fever again prevailed on Sullivan's Island. This epidemic 
was of a very malignant character. In proof of this assertion, we will refer 
to the valuable paper on this awful epidemic, by Dr. Thomas Y. Simons, in 
the Carolina Journal, for January, 1825. 

" Independent of the distresses which occurred in the city, the disease broke 
out with dreadful malignancy among those who had sought refuge from its 
ravages on Sullivan's Island, a complete sand-bank, about six miles from the 
city, which has hitherto been considered a secure retreat." P. 3. 



1854.] Porter^ Climate^ etc., of Fort Moultrie and Sullivan'' s Mand. 25 



This epidemic was much more severe among the inhabitants and residents 
of the Island than in the garrison of Fort Moultrie. On referring back to 
1824, it is found that, whilst this disease prevailed with great malignity in 
the city, not more than twelve cases, none of which proved fatal, appeared on 
the Island, in a strength of seventy." {Army Med. Statistics, p. 201.) The 
number sick in garrison was at the rate of 171 per 1,000, with not a single 
death, while the residents of the Island outside of the garrison were severely 
afflicted, and the mortality was very great. We shall return to this subject. 

In the third quarter of 1834, there are five cases of febris icterodes reported, 
two of which proved fatal. Of these cases, two originated in Charleston, and 
the other three at Castle Pinckney." — Army Med. Stats, p. 201. 

We will transcribe the important letter of Dr. Lebby to Dr. Strobel, which 
is interesting in relation to the fevers of Sullivan's Island, and other points, 
as also in connection with the subject of contagion. 

FoBT Moultrie, January 1Q, 1840. 

Dear Sir : In reply to your letter of the 6th inst., requesting any information 
in my possession relative to the fever which has prevailed in the city of Charles- 
ton for several seasons past, I have to inform you, that the first cases of yellow 
fever came under my notice, in August, 1827, at Fort Johnson. Three men 
belonging to a company of United States artillery, stationed at that post, re- 
mained a night in the city during the existence Of yellow or stranger's fever. 
On the ninth day after, they were attacked with the disease, within a few hours 
of each other. There was no doubt of the nature of the disease, it being a 
fever of but one paroxysm, and yielded on the sixth day favourably. These 
individuals were strangers to the climate, and had never been here before. 
They were natives of Germany, Ireland, and Massachusetts. They were not 
removed from their quarters (the hospital at the time being out of repair); 
and during the period of their sickness, ten or twelve men slept in the same 
room with them, who were alike strangers to the climate ; yet there were no 
other cases of disease in the garrison. The next occurrence of the disease 
was in 1831, at Castle Pinckney. One of the Irish labourers died in the city 
of supposed yellow fever. This was an intemperate man. Several other cases 
of fever occurred afterwards, among the labourers, who were brought to the 
hospital at Fort Johnson; but, according to my humble opinion, they proved 
to be bilious remittent fever, were treated as such, and recovered. 

In 1832, the disease appeared in the city of Charleston, and from two or three 
of the first cases being traced to the Irish labourers at the castle, it was sup- 
posed to have originated there; and, if I recollect aright, I think a deputation 
of the medical members of the Board of Health were sent over to ascertain, if 
possible, the cause or causes of its origin. It was ascribed by those gentlemen 
to a quantity of shells taken from the adjacent oyster banks, for the purpose of 
filling up the parade-ground. From this opinion, however, coming as it did 
from so highly respectable a source, and from gentlemen of known scientific 
attainments, I differed at the time, with due deference to their experience. 
And in obedience to an order of the commanding officer of the engineer depart- 
ment, I examined the premises, and was of opinion that the causes of the fever 
were the opening of two privies in the north wall, which had been bricked up 
for a number of years ; their contents, in a decomposed state, taken out in the 

month of August, and exposed to the action of the sun on the bank near by 

together with the exposure of the lower story of the quarters to the action of 
the atmosphere — it being necessary to rip up the floors, which had sunk down 
to the surface of the ground, and had remained in that state for some years. 
It will also be recollected that this fort had been used for some time previous 
as a lazaretto. The exposure of a surface which had been so long protected 
from the action of the sun's rays, is it not more than probable that when thus 
exposed the exhalations therefrom would engender disease of some kind ? In 



26 Porter, Climate^ etc.^ of Fort Moultrie and Sullivan's Island. [July 



this instance, likewise, every one of the cases brought to Fort Johnson was 
bilious remittent fever. Among those attacked were Lieutenant (now Captain) 
Brewerton, the master carpenter, two masons, and several black labourers. 
Yellow fever prevailed in Charleston that season, I think, to some extent. The 
venerable Dr. Philip G. Prioleau attended Captain Brewerton with me as a con- 
sulting physician, who may perhaps recollect the case. 

The next occurrence of fever under my notice, and which was confirmed 
yellow fever, was in September, 1838, the mate of one of the lighters, an Eng- 
lishman by birth, about eighteen years of age, who had been in the harbour 
about seven or eight months. He slept one night in the city, in September ; 
on the fourth day he sickened, and although he was among children at Sulli- 
van's Island, and others who were liable to contract the disease, no other 
instance of it occurred in the family. He recovered. 

The next occurrence of the fever was on the 16th of June, 1839.' Captain 

B , of the U. S. lighter Valiant, lying in the cove of Sullivan's Island, was 

taken on this date. He reported at the hospital. Fort Johnson, on 
June. This man had not been in the city, from all the information I could 
obtain, for twelve days at least previous to his attack. From the history he 
gave of himself, and the symptoms exhibited, I was of opinion that he was 
labouring under intermittent fever, resembling that form commonly known as 
country fever. In the evening there was a distinct intermission, the fever 
going off with copious perspiration. Between this period and the evening 
of the 21st, there were two distinct paroxysms. On the morning of the 22d it 
assumed the continued form ; on the 23d he commenced ejecting black vomit, 
bleeding from his blisters, mouth, and rectum; and on the 24th he died. 

The next case admitted was on the 20th of June, from the lighter Sea 
Flower, lying at the wharf at Fort Johnson. This vessel had been engaged for 
some time in transporting materials from this post to Fort Moultrie ; the cap- 
tain had not been to the city for many weeks. His symptoms were exactly 
like the first at its commencement — the paroxysms distinct, assuming the double 
tertian form, and going off in profuse perspiration, occasioning great prostra- 
tion — it yielded to a very energetic treatment, although there was great gastric 
inflammation, and some hemorrhage from the bowels. He was a very temperate, 
regular man in his habits, while the former was the reverse. 

The third case was admitted on the 22d of June. This individual wiis sent 
on board the Valiant as soon as her captain was taken sick, to relieve him. 
He was a northerner by birth, in high health, and a perfectly temperate man. 
This case was well-marked yellow fever from its commencement; it yielded on 
the night of the fifth day, and he recovered. I would here remark that this 
man had been frequently to and from the city, transporting stone to the break- 
water. On the next day a third case from the Valiant was brought to the 
hospital; this was a black man, with bilious congestive fever; and on that 
evening another black, with the same fever, from the lighter Fame, from 
Charleston. Immediately after the admission of the third case from the Valiant, 
I addressed a note to Captain Bowman, the commanding of&cer, expressing my 
suspicion that there were local causes about the Valiant calculated to generate 
disease, and suggesting to him the propriety of removing her crew (who were 
northern men) immediately, and to have the vessel ventilated and well cleansed. 
Captain Harvey, of Charleston, was placed in command of her, who stated to 
me that he found a large quantity of decomposed cabbages and potatoes, and 
other vegetable matter, in a putrid state, in her lockers, and a quantity of dirt 
and filth between her ceiling. Several of the negroes engaged in cleaning her 
were taken sick with intermittent and congestive fever. She was scuttled, and 
allowed to remain full of water for some days. After this she was pumped out, 
and continued perfectly healthy the rest of the season. 

1 In Dr. Strobel's book, the figures 1839, following the -word June, are omitted, 
•which Dr. Lobby assures me is a typographical error, and has authorized me to cor- 
rect in the proper place. Several important errors of a similar kind occur in the 
book, which was badly got up. Withoiit any authority from Dr. Lebby, and taking 
the passage as it is printed, it is evident that the June after the September of 1838 
must necessarily have been the June of 1839. 



1854.] Porter, Climate, etc., of Fort Moultrie and Sullivan's Island. 27 



The next case occurred at Fort Moultrie; an Irishman, who had not been in 
the city from May; this occurred the latter part of August. On the 18th of 
September, the assistant of Captain Bowman was taken with yellow fever. 
He had been in the city on the 10th and 17th. He recovered. On the 20th 
Captain Bowman was taken with bilious inflammatory fever. He had not 
been from Sullivan's Island during the season. Several other cases occurred 
among the families residing back of the fort; while they assumed a continued 
form of fever, and in many of their symptoms were nearly allied to yellow 
fever, it was very doubtful whether they could be properly placed under the 
head of genuine typhus icterodes. Many cases of inflammatory, or broken-bone 
fever, so called, occurred in October, among the workmen. 

In reply to the latter part of your letter, " whether they (the lighters) did 
not communicate with vessels from Havana or Matanzas, lying at the quarantine 
ground V I have taken considerable trouble to ascertain this fact, from every 
source from which a correct knowledge of facts could be derived, and I have 
no hesitation in asserting that, with one exception, there never was any commu- 
nication with the quarantine vessels and the government lighters, or with any 
one in the service of the United States. The exception alluded to was the cap- 
tain of the steamer Sumpter. On one occasion, he sent his boat on board the 
John C. Calhoun, some days after she had been boarded by Dr. Simons. No 
ill effects resulted from it, for neither of the negroes who were in the boat were 
sick afterwards. The steam-boat continued to perform her regular duties be- 
tween the city and the fort throughout the season, and though her engineer 
and mate were entire strangers, there were no cases of fever on board. 

I have thus endeavoured to- place at your disposal a plain statement of facts, 
as they occurred, under my own observation, almost from the commencement 
of my professional career. I have most carefully excluded any opinion of my 
own upon the contagiousness of yellow fever, or that fever which has prevailed 
in the city of Charleston for the last two seasons ; but, in conclusion, pardon 
me for entertaining the idea, and at the same time expressing it, that there 
were sufficient causes, both local and general, to have produced an epidemic of 
some kind. It was to be expected from the peculiarity of the season of 1838, 
as well as the extreme hot sun by day, in the latter part of May and beginning 
of June, and the cold north winds, that blew by night, at the commencement of 
the summer of 1839. 

If these sheets can be of any service to you, please make what use you deem 
proper of them. I remain, &c. 

(Signed) ROBERT LEBBY. 

Dr. B. B. Strobel, Charleston. 

— Strobel, on the Transmissibility of Yelloio Fever, pp. 190-196. 

These are the records, much more than I expected to find, in relation to 
the epidemics of Sullivan's Island during the present century, or indeed since 
the first settlement; and from them two prominent points are established, that 
yellow and other fevers did originate, from 1817 to 1839, at Charleston, 
Castle Pinckney, Sullivan's Island, and on board lighters in the service of 
the United States in the harbour of Charleston; and that none of these fevers 
were contagious. That malignant fever originated on Sullivan's Island, in 
some of these years, there is no sort of doubt. We see that these malignant 
epidemics made their appearance somewhat periodically, and at intervals of 
much less than fifty years. We have no evidence that there has ever been a 
city, town, or village entirely free from a malignant epidemic fever of some 
kind for the space of fifty years, especially from the equator to lat. 35° N. 

From 1839 to 1849, yellow fever did not appear in Charleston, but in the 
autumn of the last year the disease prevailed, and there were a number of 
fatal cases. 



28 Porter, Climate, etc., of Fort Moultrie and Sullivan^ s Island. [July 



Abstract of the Quarterly Reports of Sick at Fort Moultrie^ S. (7., for the 
year 1849. Taken sick during the year. 







>> 

i 


















u 


M 






DISEASES, 


a 
s 




o 












a 






g 


X 






P 

c3 




S-i 
«3 








'3 


p 


"ft 










"3 

"o 


"S 










< 






1-5 


< 


02 


6 






El 




Feb. intermit, quot. . . 


3 




1 




















4 




Feb. intermit, tert. . . 


4 


"i 








"i 


"2 












8 




Feb. remittens .... 


















*4 






"i 


5 




Diarrhoea 


*6 


"i 




"i 


"i 


*7 


"4 


"i 




"2 


"2 




28 




Dysenteria acut. . 


3 


1 










2 




"i 


3 






10 




All others 


19 


12 


12 


28 


ii 


16 


19 


"i 


5 


5 


"s 


"i 


142 




Grand total 


35 


15 


13 


29 


15 


24 


27 


5 


10 


10 


10 


4 


197 





MEAN STRENGTH FOR 1849. 



Month. Officers. Enlisted men. Total. 

January ...... 8 103 111 

February ...... 8 95 103 

March 8 92 100 

April 8 91 99 

May . 8 93 101 

June 8 90 98 

July 4 77 81 

August 4 54 58 

September ...... 6 46 52 

October ....... 6 53 59 

November 7 52 59 

December 7 51 58 

Aggregate .... 82 897 979 

Average 6.83 74.75 81.58 



The tables show the health of the troops at Fort Moultrie for the year, 
diseases strictly climatic being separated from all' others. But there was 
much more disease than appears on the reports. On that for the quarter 
ending September 30, are the following remarks : " During September there 
was considerable sickness, much more than appears on the face of the report, 
as a large number of women and children, belonging to the post, and left 
behind by troops in the field, were present. Their diseases were principally 
intermittents and dysentery, the last severe in many instances, but none of 
the cases were fatal." In the report for the quarter ending December 31, 
are the following remarks : " In October, while yellow fever prevailed in 
Charleston, there was considerable sickness which does not appear on the face 
of the report, being among females and children, principally bowel affections. 
November was more healthy than October, and December still more healthy, 
though in all the quarter there has been more sickness than appears on the 
report." It is to be regretted that the diseases of women and children were 
not registered. 



1854._] Porter, Climate^ etc.^ of Fort Moultrie and Sullivan's Island. 29 



GO 



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No. LY.— July 1854. 



80 Porter, Climate, etc., of Fort Iloultrie and Sullivan's Island. [July 





52.95 
2.83 
6.01 
2,59 
4.10 
0.78 
2.32 
4.03 
2.68 
0.88 
1.99 
4.64 




ooocooao'Mx>i-^=oc-i^o 


Prevail- 
ing. 


p4 h 3 fe^ 3 3 H H ^ 


COURSE OF WIND AT 
3 P. M. 


•AV 


OOTtfCq-^Or^OOi-IOi-i 


•3 1 


OOr-lr-lr-ltl<0<l^r-(OCNrH 


•AV •§ 


t~ CO CO 00 i-l CO 1-1 


O'l-I CO O r-1 01 rH 'rjl r-i CO 


1 CD CO u-J 1^ rt< (M 




•a • *s[ 


OC5'MOOOOCO-*00030CC'* 
i-l 1-1 


•M 


OO Oi-li-IOOOOIMr-irHCO 


Prevail- 
ing. 


s,- ^ i ^ ^ ^: ^ ^ i ^ ^ 

m m m m 'A i^;!^; 


COURSE OP WIND AT 
SUNRISE. 




i-l'^COCOcOOINtNCNcOC^CO 


•a 


OO-^OOi-IOOOOtN-* 


•AVS 1 


COlr-uOrHt^iOCOtM'^-^t^O 


•a-s 1 


O^OCOCOCOO^(Ni-Hr1i-HCO 


.g[ (M,-<r-lOG^eOCOCOOOOr-l 


"VVN^I t'COTt<'*(MTjt-*COTHOOOt- 


•a -NT 


OOOCOiOCOTjtO -^OC^CO 




COt-COCOCOOO-^OOOOiO 
1-1 rH . 




24.0 
32.0 
25.5 
25.0 
16.5 
20.0 
11.5 
10.0 
16.0 
25.5 
23.0 
31.5 


: ^up %sdmoo 


41.0 
32.0 
44.0 
48.0 
61.5 
^3.0 
78.5 
77.5 
68.0 
52.5 
46.5 
39.5 


:Xbp ^s^:^-^OH 


65.0 
64.0 
69.5 
73.0 
78.0 
83.0 
90.0 
87.5 
84.0 
78.0 
69.5 
71.0 




O50ooi^ooc»-*i— ii-it— coco 

C0-*-t<C0C<ICO'M(MCOCOCO'* 


•9aj:gap jsaAioT; 


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CO'MC0-*>-OiOt-l~CO':l<C0C0 


•eajs'ep ^saqjoijj 


i-l'MOOt-^COOO-^r-IO-^r- 


IlERMOMETER THERMOMETER DETACHED: 

cached: mean. mean. 


< as 


55.38 
51.17 
66.38 
62.36 
71.61 
76.23 
83.61 
83.14 
77.93 
66.40 
59.84 
56.22 




54.45 
49.82 
55.19 
60.96 
70.22 
75.23 
82.12 
81.93 
77.50 
65.83 
59.33 
54.22 


co^ 


59.83 
56.42 
60.00 
66.50 
70.83 
81.40 
88,19 
87.29 
82.76 
72.93 
66.63 
61.87 




54.38 
60.57 
56.90 
64.43 
73.61 
79.66 
86.70 
85.00 
78.90 
66.51 
59.73 
55.90j 


9 'sun- 
P.BI.^ rise. 


58.04 50.93 
57.12 45.92 
57.80 52.77 
62.51 58.23 
71.45 66.38 

76.91 71.00 
83.00 79.03 
82.89 79.00 
78.47 73.10 

68.92 59.87 
64.68 53.60 
64.78 50.32 


CO^ 


60.21 
57.22 
61.64 
67.40 
76.30 
81.41 
87.56 
86.52 
S2.04 
72.90 
68.00 
67.05 




55.19 
51.67 
67.51 
63.17 
71.91 
77.18 
83.36 
82.92 
80.00 
06.17 
02.00 
01.26 




1 s i 


53.94 
49.56' 
55.66 
60.56 
68.43 
74.03 
80.13 
80.38 
75.19 
03.96 
59.60 
59.23 


BAROMETER. | 




0.840 
1.162 
0.886 
0.827 
0.610 
0.728 
0.434 
0.413 
0.315 
0.571 
0.552 
0.630 


1 i 


29.784 
29.626 
29.666 
29.626 
29.784 
29.843 
29.921 
29.981 
30.040 
29.921 
29.921 
29.803 


Max. 


30.630 
30.788 
30.552 
30.4i33 
30.394 
30.571 
30.365 
30.394 
30.355 
30.492 
30.473 
30.433 


MONTHS. 


January- 
February 
March 
April 
May 
June 
.Tuly 
August 
September 
October 
November 
December 



O 1 kJ 



c ci "5 



. J3 3 



CO .2 

■ I- CO 
CO 



a, bfl 

.Sco a 



53 CI 

111 

PR PR 



1854.] Porter^ Climate, etc.^ of Fort Moultrie and Sullivan^ s Island. 31 
The year 1850 was sickly, as will more fully appear hereafter. 



Abstract of Quarterly Reports of Sich at Fort 3Ioultrie, S. C, for 1850. 
Taken sick during the year. 




























u 






DISEASES. 


auuary 


ebruar; 


[arch. ' 






<a 
a 

3 


3 


ugust. 


eptemb 


ctober. 


ovemb( 


ecembe 


otals. 


eaths. 




>-s 






< 






1-5 


< 


CO 







P 






Feb, contin 












1 














1 




Feb. quot. int. . . . 












1 










"i 




2 




Feb. tert. iut 














i 


1 






1 




3 




Feb. remitteus .... 
















11 


25 






"i 


39 




Diarrhoea 






"i 




*i 


'"i 










"2 


6 


11 




Dysenteria acut, . . . 












1 






1 


"i 


1 




4 




All others 


"8 




"s 


"i 


"4 


9 


9 


"5 


5 




7 


io 


70 


"2 




8 


1 


9 


4 


5 


13 


10 


17 


31 


3 


12 


if 


130 


2 



MEAN STRENGTH FOR 1850, 



Month. OfiBcers, Enlisted men. Total. 

January . . .-^ . . . 7 52 59 

February 7 52 59 

March 7 48 55 

April 7 45 52 

May . 6 42 48' 

June 5 41 46 

July ....... 5 39 44 

August ...... 5 39 44 

September . 4 40 44 

October 4 40 44 

November 8 88 96 

December 12 180 192 

Aggregate .• . . . 77 706 783 

Average .... 6.41 58.83 65.25 



Deaths, 2; one in July, from convulsions caused by obscure disease of 
the brain ; one in September, from apoplexy. Mortality per cent, for the 
year, 1.53. 

These general reports and tables give but an imperfect idea of the fevers 
in August and September; and it will be necessary to notice the epidemic 
more particularly. 

From the meteorological tables, it will be seen that the summer of 1849 
was comparatively cool and wet, and that the summer of 1850 was very hot 
and dry; but no one can form an idea of the continued and intense heat 
during the summer of the latter unless he had been a resident, or has an 
opportunity to study the daily meteorological observations of that period. 
From the 26th day of June to the 8th of September, there were only six 
days in which the daily mean of the thermometer did not range from 80° to 
90°; there was only one day in July when the daily mean of the thermome- 
ter was not 80° and above; there were only five days in August in which 



32 Porter, Climate, etc., of Fort 3loultrie and Sullivan's Mand. [July 

the daily mean was not 80° and above; and tliere were twelve days in Sep- 
tember in which the daily mean was 80° and above. In July, the thermo- 
meter ranged as follows: S. R. from 74 to 86; 9 A. M. 80 to 89; 3 P. M. 
81 to 95 ; 9 P. M. 77 to 86. August :• S. E. 73 to 84 ; 9 A. M. 79 to 90; ■ 
3 P. M. 78 to 94; 9 P. M. 77 to 86. September : S. R. 60 to 80; 9 A. M. 
65 to 88; 3 P. M. 76 to 91; 9 P. M. 67 to 85. 

Eealtli of Charlestorij previous to the Epidemic. — Yellow fever in the 
autumn of 1849; scarlatina, and other eruptive fevers, during the following 
winter, and in the spring of 1850. 

Health of Sullivan's Island. — In the summer of 1849, bowel complaints 
and intermittents. No yellow fever in the fall of 1849, as in Charleston. 
In the following winter there were catarrhal affections and diarrhoea, particu- 
larly among children. Pertussis was common. In April, 1850, scarlatina 
broke out, supposed to have been introduced from Charleston, although direct 
contagion could not be traced in many of the cases. A number of severe 
cases, of the anginose and malignant varieties, occurred in the months of 
April, May, and June, several of which proved fatal. The chlorate of potass, 
and the chlorine mixture, as recommended by Watson, were tried, but with- 
out the least benefit. In some of the last cases inunction was tried, as I 
thought, with good effect. Olive oil was used. Oily or greasy applications 
to the surface appear to act by softening and preserving the cuticle, and per- 
haps the cutis vera itself, in a healthy state; the action of the skin is not 
checked as when the cuticle dries, cracks, and peels off; and, in consequence, 
dropsical effusion, the most dangerous of the sequelse, is not so common, ex- 
tensive, or fatal. In June and July, bowel affections, including cholera 
infantum, were common and severe among children. Prickly heat (lichen 
tropicus) was universal, from infancy to threescore and ten; boils were 
almost universal; and phlegmonous and carbuncular abscesses were extremely 
common. 

The epidemic fever began in Charleston in July, if I mistake not, but its 
appearance on Sullivan's Island was later, and it spread rapidly and univer- 
sally, scarcely a single person in a family escaping. The fever did not, for 
some reason or other, attack the garrison of Fort Moultrie this year until it 
had spread to almost every part of the island, and for a time there seemed to 
be a protecting line drawn around the public grounds; but when the fever 
did come, it came like an avalanche, and swept all before it. The first case 
of the epidemic fever in garrison occurred on the 20th of August, and the 
epidemic was nearly over by the end of September, there being only two 
cases in the month of October. 

Symptoms. — A few of the prominent ones will be given. Cephalalgia was 
general in the early stage, often severe in the orbitar and frontal regions ; 
occasionally the eyes were suffused and a little injected — all going off as the 
disease progressed, or was under treatment ; and pain of the back and limbs 



1854.] Porter, Climate, etc., of Fort Moultrie and Sullivan's Island. 33 

was universal. Gastric irritability was freqiieDt, and pain or tenderness of 
the epigastrium almost universal. The skin was sometimes hot and dry ; 
oftener there was not much heat, but a tendency to clammy perspiration, or 
cold and profuse sweat. The patients with hot and dry skin were regarded 
in much the most favourable light, having less of the congestive character. 
Tongue of all appearances, clea.n, yellow, white, moist, or dry. In some of 
the most serious cases the tongue had red edges, becoming dark-brown and 
dry in the progress of the disease. Hemorrhage was common, generally ute- 
rine in the female, often causing abortion in pregnancy; in the male, epis- 
taxis. As the tendency of this epidemic was to recovery, these varieties of 
hemorrhage mostly came on early in the disease, and were often critical, or 
the precursors of convalescence. 

Treatment. — The disease being a fever with tendency to congestion, the 
treatment was similar to that adopted in the Florida fevers in 1839, 'AO, and 
'41. The following is from my report to the Surgeon-Greneral. 

The cases of fever which came under my own observation both in garri- 
son and beyond it, very much resembled those at Fort King, Florida, in 
1841. These exhibited considerable tendency to congestion, like the Florida 
fevers. One of the worst cases of congestive fever I have ever seen originated 
on this island, in the person of a married female, of good habits and charac- 
ter, who had not been from the island for more than six weeks previous to 
the attack, and who had not stayed from the island at night for more than six 
months.'^ 

" Sulphate of quinia was the main remedy. It was given, with calomel, as 
a cathartic, early in the disease, and this dose was generally followed by ol. 
ricini. In a few cases, where there was vigour of the circulation without gas- 
tric irritation, quinia was given with tart. ant. potassse until the pulse was 
reduced. A combination of sulph. quin. and capsicum was an invaluable 
remedy. These two articles were often given at the very commencement, and 
almost always in the progress of all cases. There was tendency to congestion, 
often from the first, almost always in the progress; hence the value of this 
combination. In a case (a company laundress) of relapse, attended with rapid 
and feeble pulse, great thirst, pungent heat of skin, &c. quinia and capsicum 
were freely used, and in the course of eighteen hours the patient was con- 
sidered out of danger. Unfortunately, in about twenty-four hours from the 
second attack of fever, abortion of a three months' foetus (with considerable 
hemorrhage) occurred, reducing the patient to an extreme condition. The 
combination of quinia and capsicum was steadily continued, in addition aeth. 
sulph., brandy, &,c., until the urgent symptoms passed off, and the patient 
recovered. 

The case of congestive fever alluded to terminated fatally, with all the 
symptoms of apoplexy. A few additional remarks will close the treatment. 
Venesection was scarcely thought of. Free cupping, often dry, to the cervi- 
cal spine, lumbar region, and epigastrium, was general. Sinapisms were in 
universal use ; and blisters were often employed in the severe cases, oftenest 
to the epigastrium, and frequently over the cervical spine. In all cases, from 
the beginning, quinia was the sheet-anchor, nearly always combined with the 



34 Porter, Climate^ etc.^ of Fort Moultrie and Sullivan^ s Island. [July 



infusion of capsicum. In a few grave cases, with brown and dry tongue, 
calomel in broken doses was combined with quinia, with excellent effect. 
Ptyalism was avoided, occurring only once, slightly, in a severe case with dry 
tongue, sordes, &c. So soon as slight tenderness of the gums came on, im- 
provement was rapid. The various preparations of opium were in general 
use at night, morph. sulph. most frequently. Wine, brandy, and malt liquors, 
according to the taste of the patient, were pretty freely used. 

MEDICAL STATISTICS OF FORT MOULTRIE, EPIDEMIC OF 1850. 

No. exempt 

No. present. No. of fever cases. Deaths. from fevers. 

Officers and men 48 38 10 

Women, children, and servants 49 43 6 

97 • 81 16 

We have 38 fever cases among 48 officers and men, or 79.16 per cent.; 
equal to 791 per 1,000. Women, children, and servants, 49 present, and 
43 cases of fever; 87.75 per cent., or 877 sick per 1,000. In a total of 97 
persons, there were 81 sick with fever, 83.50 per cent., or 835 per 1,000; 
and the number of persons who escaped fever was only 16, or 16.50 per cent, 
of the whole; equal to 165 per 1,000. This in less than two months, the 
first being taken sick August 20, the second August 23, and the last October 
14. Indeed, deducting two cases on the 5th and 14th of October, we find 
that the whole of this sweeping epidemic took place from the 20th of August 
to the 30th of September, or in the space of forty-two days. 

Case 1. — Mrs. S , residing in Middle Street, near the steamboat land- 
ing, or ferry wharf, was taken with congestive fever; but I did not see her 
until a day or two had elapsed, or on the 12th of August. Died on the 14th. 
This is the case alluded to in my report to the Surgeon-Greneral. She had 
not been in town, or from the island, for more than six weeks, as she told me 
on my first visit, and had not slept from home for months. 

Case 2. — The infant of Mrs. S , above mentioned, seven months old, 

was taken with malignant cholera infantum on the 18th of August, and died 
on the 27th. Had not been in Charleston, or from the island, during the 
summer. The late Dr. Gr. W. Ramsay saw both of these cases with me, 
and we had several conversations in relation to their origin, both of us being 
satisfied that they originated on Sullivan's Island. 

Case 3. — A child of Corporal Dounan, Company I, 2d Artillery, eight 
months old, was taken with cholera infantum in the month of June, and on 
the 10th of July it was considered moribund. The condition of the child at 
this date was as follows: emaciation extreme; pulse small, and very frequent; 
stomach had become quiet, and the bowels much more so than previously; 
skin clammy; no use of the limbs, apparently; thumbs drawn down into the 
palms ; slept with one eye partially opened, as we often see in the cases of 
very sick children, but the other eye was wide open during sleep ; ulceration 
of both cornea — in fact, the patient was given up. Regarding the state of 
the patient as hydrencephaloid, and consequently that the smallest depletion 
must prove fatal, the general treatment was continued : small and repeated 
doses of aqua a.mmoni9e, sulph. quin., brandy, wine-whey, minute doses tinct. 



1854.] Porter, Climate^ etc., of Fort Moultrie and Sullivan^ Island. 35 

opii, &c. Tinct. ferri was used after small doses of acet. plumbi were with- 
drawn. The child lingered until cold weather came, and finally recovered, to 
the surprise of every one. Lieut. -Col. Erving will recollect this case. The 
child had not left the island during the spring and summer. 

Case 4. — Elizabeth Dounan, mother of case 3, was taken with the prevail- 
ing epidemic in September. This case, of relapse and abortion, has been 
already sufficiently alluded to. There was no arthritic disease in this case, 
neither was there any eruption, except prickly heat, which she had had during 
the whole summer. Had not been in Charleston for weeks. 

Case 5. — A child of private Bronsman, Company I, 2d Artillery, thirteen 
months old, was taken with cholera infantum in the month of July, and in 
August was given up as lost. As cold weather came on the child gradually 
recovered, but was troubled with diarrhoea during the whole of the subsequent 
winter. Did not leave the island during the summer ; never slept out of gar- 
rison parade. This child, and Corporal Dounan's, would have been sent to 
Aiken, or to Buncombe, or to the White Mountains, had not the means been 
wanting. 

Cases 6, 7, 8. — In a small, uncomfortable house, near the ferry wharf, 
three persons resided, 'a man, his wife, and another woman. The wife was 
taken with the epidemic fever on the 23d of August, the other female on the 
24th, and the man on the 25th. All had the fever severely; all complained 
of intense pains in the frontal and orbitar regions, and all had hemorrhage. 
The two females had profuse uterine hemorrhage, and the man had epistaxis. 
No boils, or eruptions, except prickly heat. No arthritic disease. All had 
severe pains in the lumbar region and limbs. 

Case 9. — Judy, a female black servant of my own, about 55 years of age, 
had the fever severely in the last part of August. Had intense pain in the 
frontal region and orbits, severe pains in the lumbar region, and epistaxis. 
Had this woman been only 25 or 30 years of age, there would probably have 
been uterine hemorrhage, but the critical time of life having passed, epistaxis 
occurred. She did not leave the island during the summer, and never left 
the house and yard (between the fort and hotel, on Middle Street) except on 
Sunday afternoon. Recovered. 

Case 10. — My other servant, a dark coloured boy verging to black, 17 or 
18 years of age, had the fever still more severely in the early part of Sep- 
tember. He had intense pain in the frontal and orbitar regions, suffusion of 
the eyes, and profuse hemorrhage from the nares. He was severely sick for 
several days. Had not been in town for weeks. Recovered. 

Case 11. —Mr. G , residing in Middle Street, about half-way between 

the fort and ferry wharf, was taken with this fever on the 4th of September. 
Had visited Charleston daily, but never stayed over night. Had intense pains 
in the frontal region and orbits, and back and limbs, and the disease speedily 
assumed the congestive character. At one time he was considered in a very 
dangerous condition. Recovered. 

Case 12. — Corporal David Dounan, Company I, 2d Artillery, was admitted 
into hospital with the prevailing fever on the 6th of September. When 
first taken he had severe pain in the frontal region, back and limbs, and ten- 
derness of the epigastrium ; in the progress of the case, the tongue had red 
edges, and its surface became black and dry; sordes; and the heat of skin 
was pungent to the touch, xis the disease advanced, there was restlessness 
and muttering delirium at night, but there was no delirium during the day. 
Calomel and quin. were given regularly to this patient; sinapisms, cups, and 
then blisters, to the mastoids, cervix, and epigastrium were applied; and 



86 Porter^ Climate, etc., of Fort Moultrie and Sullivan's Island. [July 



camphor and sulpli. morpli. were administered at night. So soon as the teeth 
became slightly tender, improvement was rapid. Recovered. This was a 
very sick man, and for a few days the result was doubtful. Three or four 
similar cases occurred among the men in hospital. 

Case 13. — Ann C , of Charleston, residing temporarily on Sullivan's 

Island, Irish, about 25 years of age, married, dissipated, was taken with the 
fever in August; had severe pain of the forehead and eyes, back and limbs; 
uterine hemorrhage, and she finally had a miscarriage. Recovered. 

Case 14. — Ann Boyle, Irish, wife of a private of Company I, 2d Artillery, 
about 35 or 40 years of age, had the fever in August; had intense pain in 
the frontal region, back, and limbs; and uterine hemorrhage. Recovered. 

Case 15. — -Mary Boyle, daughter of the above, 10 or 11 years of age, 
had the fever in August ; had severe pain in the frontal region, and epistaxis. 
Recovered. 

Cases 16, 17, 18. — Isabella, coloured, residence on the back beach N. E. 
of the fort, was taken with the epidemic fever on the 20th of August. Had 
severe pain of the frontal and orbitar regions; and the eyes were tender to a 
slight pressure, and suffused. She was very ill for three or four days. Her 
son, about 3 years of age, was taken with the fever on the 4th of September. 
Eyes suffused ; epistaxis. Both recovered. She lost an infant with malignant 
cholera infantum in the last part of July, which child had not been from the 
island for a number of weeks. 

Cases 19, 20, 21, 22. — Margaret Masterson and her family. Margaret 
was a widow, about 40 years of age, Irish, and a laundress of Company F, 
2d Artillery, her husband having been a private in that company. She had 
the fever severely in the last part of August : intense pain in the supra- 
orbitar region ; suffusion of the eyes ; and uterine hemorrhage. During con- 
valescence she had an enormous abscess on one arm. Her three children had 
the fever at the same time, and altogether it was a helpless family, being 
for several days entirely supported from the hospital. One of these children 
had epistaxis; another was troubled with boils, both before and after the 
fever. 

These brief notices of cases, made for the purpose of showing the nature 
and origin of the fever, are sufficient. Whole families were sick with the 
epidemic disease at the same time, and it was not uncommon to have difficulty 
in finding well persons sufficient to assist the sick. In one family, on Mid- 
dle Street, I had four sick patients at the same time, two of them danger- 
ously ill ; and in another family in the same street, about one-quarter of a 
mile from the ferry wharf, there were five sick with fever at the same time, 
one of whom I considered dangerously ill. In the family of one of the 
officers, Rev. Mr. Harris's, Post Chaplain, residing at Bulow's house near the 
fort, there were six fever patients, every person in the ^lOuse, nearly at the 
same time, and every one had the fever severely. Such instances were far 
from uncommon ; in fact, they were very common, for the disease was wide 
spread, universal, over the whole island. The physicians of Sullivan's Island 
had a hard time of it that year, for although there were three or four of them, 
there was altogether too much for them to perform; and most of them sickened, 
sooner or later, during the epidemic, with the prevailing fever Indeed, so 



1854.] Porter, Climate, etc., of Fort Iloultrie and Sullivan's Island. 37 

universal was the fever among the women and children attached to the garri- 
son, that they received their nourishment — tea, arrow-root, chicken broth, 
beef tea, &c., for a time, entirely from the hospital. Happily, the fever was 
not of long duration as a general thing, nor was it fatal, but the suffering was 
great. 

What was this fever ? Dr. Dickson, Dr. "Wragg, and many other of the 
Charleston physicians, and also several of the Augusta, Savannah, and other 
southern physicians, think it was the true dengue. Then, what is dengue ? 
My limits forbid more than a reference to the descriptions and opinions of 
Surgeon- Greneral Lawson, at Pensacola, 1828 ; Dr. Dickson, Charleston Dr. 
Waring, Savannah; Dr. Dumaresq, New Orleans; the West India physicians; 
and many others, all writing about the same period of time, about 1828. 
From all the authorities, we are warranted in concluding, that dengue, throw- 
ing adventitious symptoms aside, is a febrile arthritic disease, coupled with 
exanthema. 

1. The arthritic affection. — Dr. Lawson says that " the fever usually ran 
very high, and continued, without a remission, from twenty to thirty-six 
hours ; after which it subsided, leaving the patient in a state of extreme de- 
bility, and labouring under an acute rheumatic affection of the muscular sys- 
tem generally." Dr. Dickson says : " Of all the symptoms of dengue, the 
affection of the joints was the most tenacious and troublesome, adhering for 
weeks to some patients, and constituting a sort of permanent lameness, or loss 
of mobility." Dr. Dumaresq observes : " This was a singular termination of 
the disease, leaving sufferers from the fever hardly able to move about ; and, 
indeed, the appearance of persons in the street must have been truly pitiable 
to a healthy stranger — here, one seen dragging his legs after him, supported 
on crutches ; and there, another, with limping gait and various contortions 
of countenance, bespeaking that his tardy progress was made at the expense 
of hjs bodily feelings." Not a single instance of the disease termed dengue, 
as above described, came under my notice during the season, either among 
my own patients, or among the host of patients treated by other physicians. 

2. The eruption. — It has been already mentioned that cutaneous complaints 
were universal before the epidemic fever commenced, as different varieties of 
lichen, boils, and phlegmonous and carbuncular abscesses. One person, 
covered with prickly heat, had more than twenty small boils from one elbow 
to the wrist, answering the description of the phlegmoid eruption of the 
denguists; but the person in question did not have a single symptom of the 
epidemic fever, although he had a large and troublesome abscess on one of 
the nates in the month of September. But from fever he was entirely free. 
Cases occurred in children, long before the epidemic fever broke out, in 
whom boils were almost universal, on the chest, neck, and scalp, particularly, 
there being at the same time a perfect sheet of prickly heat over the body. 
These eruptions, boils, abscesses, &c, were extremely common long before the 



38 Porter, Climate, etc., of Fort Moultrie and Sullivan's Island. [July 

epidemic, and were regarded as the effect of intense solar heat. The entire 
absence of arthritic disease, and of an eruption coinciding with the fever, led 
me to conclude, both during the epidemic and afterwards, that the disease 
was not dengue. 

I do not pretend to say that other physicians did not treat cases of dengue, 
abundance of cases; and it would be nonsense in me to dispute the testimony 
of members of the profession in Charleston, Savannah, Augusta, and many 
other places. I simply mean to say that, during the year 1850, I did not 
see a single case of dengue myself, and describe the fever as it ran its course 
among my own patients. 

The epidemic disease was mostly southern bilious remittent fever, sometimes 
continued fever, with tendency to congestion. In this, I am convinced that 
my opinion was correct, as far as it went. But after reflecting upon the 
prominent symptoms of the fever, and especially after comparing them with 
the epidemic of 1852, it is my opinion that the disease made a near approach 
to yellow fever. The prominent symptoms, in the early stage and progress, 
were those of yellow fever, as given by me in Fenner's Southern Medical 
Reports, vol. ii. pp. 380-381, viz: ^^Cephalalgia was general in the early 
stage, often severe in the frontal and orbital regions — occasionally, the eyes 
were suffused and a little injected — all going off as the disease advanced or 
was under treatment. Hemorrhage was common ; uterine in the female, often 
causing abortion in pregnancy; in the male, epistaxis.'^ Dr. Fenner speaks 
of the hemorrhagic tendency in the fevers of New Orleans this year. Every- 
thing considered, it is my opinion, that only one turn more of the screw'^ 
was wanting to develop well-marked yellow fever, or in other words, malig- 
nant yellow fever; and it may be, after the uncommonly hot and dry weather 
of the spring and summer, from the fii'st of April to the last of July, that 
the one thing required to bring out the disease in a marked degree, was a 
deluge of rain in the month of August, or by the first of September. ^ The 
quantity of rain which fell from the fii'st of August to the 12th of September, 
1852, was 13.55 inches; and if the same quantity had fallen in the same 
time in 1850, no one can estimate the consequences. 



1854.] Porter^ Climate^ etc., of Fort Moultrie and Sidlican's Island. 



39 



-trcnb 



jars 



mmmm 



rt ^ = ^ , 



^ o cci .n = ^ o ^ 



^) ^1 o o o ^4 ?a -1 T 



I o o o ^ ^ X 



C5 l:^ -* O O r-, 




Hi 



2 2 



I* 



liiiiiliHi 




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^ililMil 



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r I 

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mmmi 

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1-: ^ P=iP=-<;-;-?T) i-:<!0 



40 Porter, Climate j etc., of Fort Moultrie and Sullivaris Island. [July 



1851. This year was comparatively healthy. The number of companies 
in Charleston harbour was seven ; four at Fort Moultrie, two at Fort Sumter, 
and one at Castle Pinckney, all under my medical charge. The hospital of 
Fort Moultrie was the general hospital for the sick in the whole harbour ; but 
I have carefully separated the cases which strictly belong to the garrison of 
Fort Moultrie from all others. 



Abstract. Taken sich during tlie year. 



DISEASES. 


j January. 


S 

u 


March. 


April. 


May. 


June. 

1 


July. 


August. 


September. 


1 October. 


j November. 


December. 

1 


Totals. 

I 


Deaths. 


Feb. catarrhalis . . . 




1 






















1 




Feb. int. quot 


"i 






i 


1 
















3 




Feb, iut. tert 


1 


*4 


"e 


3 


2 






'2 










18 




Feb. remittens .... 




1 


1 




5 


4 






"3 


"i 






15 




Feb. contin 












1 


2 












3 




DiarrhiDea 


"i 






2 


1 


2 


11 


7 


"2 


"5 


"2 




33 




Dysenteria acut. . . . 




"i 


"l 


2 


1 


3 


6 


1 


2 


7 


1 




25 




Dysent. cliron. 






1 




















1 




All others 


19 


14 


18 


7 


"s 


18 


46 


46 


24 


36 


17 


17 


250 


*4 




22 


21 


27 


15 


18 


28 


65 


56 


31 


29 


20 


17 


349 


4 



MEAN STRENGTH. 



Months. 
January 
February 
March 
April . 
May 
June 
July . 
August 
September 
October 
November 
Pecember 



Aggregate 
Average 

Deaths, 4 ; one in March, from fracture of the cranium and meningitis ; 
one in May, of enteritis, chronic dysentery supervening; one in November, 
of phthisis pulmonalis; and one in December, a deserter, who had country 
fever in his absence, was admitted for general debility, and at last died of 
chronic dysentery. Number of cases during the year, 349.* Mortality per 
cent., 1.14. 

We have seen that 1850 was exceedingly unhealthy, and that 1851 was 
the reverse ; it should be expected, therefore, that great meteorological dif- 
ferences would appear, but this is not the fact in relation to solar heat. The 
mean summer temperature for the two years is shown in the following table. 



Officers. 


Enlisted men. 


Total. 


15 


183 


198 


16 


180 


196 


14 


173 


187 


14 


169 


183 


13 


164 


177 


12 


189 


201 


11 


199 


210 


10 


188 


198 


11 


175 


186 


11 


199 


210 


12 


2L1 


223 


12 


198 


210 


151 


2,228 


2,379 


12.58 


185.66 


198.25 



1854.] Porter, Climate^ etc., of Fort Moultrie and Sullivan's Island. 41 



MONTHS. 


1850. 


1S51. 


Sun- 
rise. 


9 A.M. 


sp.M.jgp.M. 


Daily 
mean. 


Sun- 
rise. 


9 A.M. 


3 P. M. 


9 P. M. 


Daily 
mean. 


May 

June ...... 

July 

August 

September .... 


66.38 

71.00 
79.03 
79.00 
73.10 


73.61 
79.66 
85.70 
85.00 
78.90 


76.83 70.22 
81.4675.23 
88.1982.12 
87.29 81.93 

82.76 77.50 

1 


71.61 
76.23 
83.61 
83.14 
77.93 


67.64 
74.56 
78.32 
78.29 
68.06 


76.38 
80.80 
83.32 
83.16 
76.00 


77.77 
82.53 
88.67 
86.03 
79.46 


72.00 
77.90 
81.03 
81.09 
73.76 


72.70 
78.55 
83.50 
82.16 
73.76 



It is to be distinctly understood, that in the meteorological table^for 1850, 
'51, '52, '53, the highest degree put down in summer, in all cases, is the 
highest degree at any time of the day, irrespective of the time of regular ob- 
servation, although the mean temperature is the result of the regular observa- 
tions. Thus, the highest degree in the table for 1851 is 100, though the 
highest degree at any regular observation was 99 ; and so of the rest. The 
lowest degree is the lowest of the regular observations at sunrise. 

From the foregoing little table, it appears that the heat in both years was 
excessive; but there is not so much difference as might have been expected. 
The month of July was excessively hot in both years, most so, however, in 
1850; and the following extract from the meteorological register of the hos- 
pital, showing the temperature^for the last eight days of the month, may not 
prove unacceptable. 









1850. 










1851. 






JULY. 
























Sun- 


9 A. M. 


3 P.M. 


9 P.M. 


Daily 


Sun- 


9 A.M. 


3 P. M. 


9 p. M. 


Daily 




rise. 








mean. 


rise. 








mean. 


24tli 


81 


85 


86 


82 


83.5 


80 


84 


88 


82 


84,0 


25th 


80 


86 


86 


81 


83.0 


81 


84 


88 


80 


84.5 


26tli 


79 


86 


93 


85 


86.0 


76 


88 


87 


83 


81.5 


27th ...... 


80 


89 


81 


81 


80.5 


79 


84 


94 


84 


86.5 


28th 


80 


88 


89 


82 


84.5 


82 


88 


99 


87 


90.5 


29th 


77 


88 


89 


84 


83.0 


82 


88 


96 


78 


89.0 


30th 


83 


88 


90 


85 


86.5 


81 


88 


94 


84 


87.5 


81st 


82 


89 


88 


85 


85.0 


78 


85 


92 


78 


85.0 


Average mean temp. 


80.25 


87.37 


87.75 


88.12 


84.0 


79.87 


85.50 


92.25 


82.00 


86.06 


Hottest day .... 


86 


85 


94 


84 


90.0 


82 


88 


99 


87 


90.5 


Coldest day .... 


74 


82 


83 


79 


78.5 


70 


81 


82 


77 


76.0 




12 


3 


11 


5 


11.5 


12 


7 


17 


10 


14.5 



But if there was not a vast disparity of solar temperature, there was a great 
difference in the quantity of rain which fell in the different months and 
seasons : — 



January 
February 
March 
April 



1850, 


1851. 


Months. 


1850. 


1851. 


2.95 


3.67 


August 


. 4.03 


5.89 


2.83 


2.51 


September 


. 2.68 


0.29 


6.01 


1.93 


October 


. 0.88 


1.28 


2.59 


1.65 


November 


. 1.99 


3,34 


4.10 


0.63 


December . 


. 4.64 


1.10 


0.78 


8.25 








2.32 


8.52 


Total quantity, 


inches 35.80 


39.06 



June 
July 

Had there been powerful rains in September of each year, such as fell in 
September, 1852, no one can tell the consequences. 



42 Porter; Climafe, etc., of Fort Moultrie and Sullivan s Hand. [July 



mmrnm 



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^1 - O O O r- rH M O iT" 



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m 



imi 



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ill 



Im 



HI 



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ii I 




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ml I 



ill 



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if Slir 



B mm i 



1854.] Portei'j CUmaie, etc., of Fort Moultrie and Sullivan's Island. 43 
We come to the epidemic fever of 1852. 



Abstract of the Quarterly Reports of Sick at Fori 3IouItrie. Taken Sick 

during the year. 

































DISEASES. 




uary 








o 




3 


embe 


M 


3mbe 


imbei 








g 
3 


1 


1 Man 

1 


Apri 


May 


c 

3 


>> 

3 
1-5 


Aug 


Sept 


1 Octo 
1 





P 


3 


Beat 


Feb. contin 
















2 










2 




Feb. icterodes .... 


















"i 


29 


"3 




33 


"4 


Feb. int. tert 














'i 


"i 










2 




Feb. remittens .... 


















24 


"3 


*i 




28 




Diarrhoea 








1 




"i 


"i 








1 




6 




Dyseuteria acuta . . . 






"i 


1 












"1 


2 




5 




All others 


23 


li 


5 


6 


7 


"i 


"e 


7 


"5 


5 


12 


io 


101 






23 


11 


6 


8 


7 





9 


10 


30 


38 


19 


10 


176 


4 



Deaths^ 4 ; three in October^ and one in November, all of yellow fever. 



MEAN STRENGTH. 



Months. ^ Officers. Enlisted men. Total. 

January 13 190 203 

February 11 156 - 167 

March 8 92 ' 100 

April 8 84 92 

May 7 78 85 

June ....... 8 70 78 

July ....... 7 67 74 

August 7 64 71 

September 7 64 71 

October 9 104 113 

November 9 98 107 

December 9 89 98 



Aggregate . . . .103 1,156 1,259 



Average . . . . 8.58 96.33 104.92 



Cases of Fever during the Epidemic — Case 1. — Private Joseph Dunn, 
Company K, 2d Artillery, was admitted on the 22d August with bilious con- 
tinued fever. This was not a severe case, and the patient soon recovered. 
He had not been in town, or from Sullivan's Island for several months, and 
there is no hesitation in saying that his disease originated on the island. 
Hard drinker. 

Case 2. — Col. M was taken with severe congestive tertian intermit- 
tent on the 29th of August, having been unwell three or four days previous. 
This case originated in fishing excursions to the west end of Long Island, 
which is near the east end of Sullivan's Island. The Colonel being exposed, 
on his return, to the damp evening air and malaria during the passage of his 
boat from the former island, through the creek or passage between the main- 
land and the back beach of Sullivan's Island to the fort-wharf. Col. M. 
stated to me that he had not been subject to any form of intermittent fever 
for many years. This was a severe and very obstinate case ; during every 
paroxysm there was congestion of the brain, which was so great in the last 
one that his situation was considered dangerous. Recovered. 



44 Porter, Climate, etc., of Fort Moultrie and Sullivan^ s Island. [July 

Case 3. — Private George Hepp, Company E, 2d Artillery, was taken with 
bilious continued fever on the 31st of August. This was a mild ease. Hepp 
was an old soldier, and had just re-enlisted (on the 20th of August), previous 
to which he states that he resided on a farm four or five miles from Charles- 
ton, where the fever was doubtless contracted. Attacked with remittent fever 
on the 17th September. Sober. 

Case 4. — Private John Roberts, Company K, 2d Artillery, drunkard, was 
taken sick with mild remittent; origin unknown. 

Hitherto the fever was mild, scarcely worth attention, nor would it have 
been noticed but for what followed. The epidemic really .broke out in a de- 
cided manner on the 7th and 8th days of September, the rain pouring down 
in torrents, and the parade being nearly under water. From 7 A. M. of the 
7th to 2 P. M. of the 8 th, four inches of rain fell. From 7 P. M. of the 4th 
to 2 P. M. of the 8th, no less than 9.40 inches of rain fell, or 1.88 inches 
per day; and this quantity added to 8.86 inches in June, 5.43 inches in July, 
and 4.15 inches in August, makes the enormous quantity of 27.84 inches in 
three months and eight days. More than an average quantity (4.17 inches) 
fell in the May previous. 

We will first notice the cases in the soldiers' families residing on the parade, 
which extends from Middle Street (this street runs between the fort and 
parade) to the back beach; next, the cases which occurred in the fort; and 
lastly, cases entirely detached from the fort and parade. 

Case 5. — Dominic Duffy, 1st Sergeant of Company K, 2d Artillery, 
quarters on the east side of the parade, was taken sick with fever, registered 
remittent, on the evening of the 7th September. Sober; conduct unexcep- 
tionable. R. 01. ricini ^i. 8th. Removed to hospital early this morning ; 
severe headache; skin hot and dry; pulse full; tongue coated yellow. Oil 
had operated. Cup the cervical spine. R. Quin. sul. grs. x; hyd. prot. 
chlorid. grs' v. 9 A. M. R. Quin. sul. grs. v, at 1. 6 P. M. It is un- 
necessary to pursue the treatment further. Returned to duty on the 20th. 
Sergeant Duffy, wife, and Margaret Cooney, who lived with them, went to 
Charleston last on the 24th day of August, in the 2 o'clock P. 31. steamboat, 
and returned in the 5 o'clock boat, thus being in town but little more than 
two hours. Having heard that yellow fever was in town, they passed directly 
through Market Street, from the steamboat wharf, to King Street, and when 
their purchases were made, all three returned through Market Street to the 
steamboat. King and Market Streets were the only streets entered. Never 
remained in Charleston over night. None of them went to town after the 
24th of August ; Ann Daffy, the wife, was taken with yellow fever on the 
16th of October; Margaret Cooney remained in perfect health. 

Case 6. — Mary Stolper, wife of Sergeant Stolper, Company E, 2d Artillery, 
, quarters on the east side of the parade, was ill on the evening of the 7th of 
September, and early on the morning of the 8th I saw her. The disease was 
registered as remittent fever; but there was intense pain in the frontal and 
orbitar regions, and of the back and limbs, and tenderness of the eyes on 
slight pressure, with suffusion. This fever was easily broken up by calomel 
and ol. ricini, and the free use of quinia ; but the intense supra-orbital pain 
and suffusion induced me to think, and to express the opinion that yellow fever 
might occur. The case served a good purpose, it put us on our guard. This 



1854.] Porter, Climate, etc., of Fort Moultrie and SuEiuan's Island. 45 



patient had not been in Charleston since the 17th of x^ugust, twenty-one 
days at least before the attack, when she visited her brother, who was sick 
with " some kind of fever," as she expressed it. Never slept in town. This 
case was in fact a very slight one, and merits notice only as occurring at the 
particular date, the 7th and 8th of September. 

We now come to the Brassard family, quarters on the west side of the 
parade. Charles Brassard, one y6ar old, was attacked late on the 5th of Sep- 
tember with encephalitis, and died on the 6th, eighteen hours after the first 
visit. Had not been from the island. 

Case 7. — Eleanor Brassard, 7 years of age, was taken with severe fever, 
registered remittent, in the livery of yellow fever, on the 7th of September. 
Had not been from Sullivan's Island for twelve months. Had severe pain 
of the frontal region and orbits, eyes suffused, tenderness of the globes, and 
intense pain in the lumbar region and limbs. Had epistaxis on the 8th. 
Took calomel and quinia on the first day, and ol. ricin. and the quinia was 
continued, more or less, until convalescence was established. This case also 
served to point out that yellow fever was approaching. This patient was 
scarcely able to sit up when her mother was taken sick with yellow fever. 

Case 8. — Mary Ann Brassard, mother of Case 7, wife of private Brassard, 
Company E, 2d Artillery, wa^ attacked with severe yellow fever on the 15th 
of September. She had intense pain in the frontal region and orbits, tender- 
ness of the eyeballs on slight pressure, sufi"usion of the eyes, and the vessels 
of the conjunctiva were injected. She had also severe pain in the back and 
limbs, and pain in the epigastric region. The youngest child (Charles Bras- 
sard) was weaned in June, on account of the milk disagreeing, and the cata- 
menia had appeared three times since, with great regularity " to the very day." 
Had profuse epistaxis on the night of the 16th. On the morning of the 17th, 
two weeks after the regular catamenial period, profuse uterine hemorrhage 
came on, continuing to the 23d, which was much worse at the commencement, 
on the 17th, 18th, and 19th, than at any time subsequently. Yellow skin on 
the 1 8 th. This case was treated with calomel, quinia, and ol. ricin. with sinapisms 
and cups to the mastoids, cervical spine, ,and epigastrium on the first day, and 
afterwards, blisters to the cervix and epigastrium. Afterwards, the calomel in 
smaller doses was continued with the C{uinia, and morphia at night. Gums 
touched on the 18th. Was finally put upon ammonia and camphor mixt., 
wine, chicken tea, beef tea, &c. Recovered. This patient had not been from 
Sullivan's Island since the 15th of August — exactly one month before the 
attack of fever. Never had stayed in town over night ; and she stated to me 
during her sickness, and afterwards, that she had not seen a single person 
sick with fever during the whole summer except in her own family, the 
daughter mentioned, Eleanor Brassard. And she was confident that her 
daughter had seen no case of fever whatever, and I certainly know that she 
never did. I have implicit confidence in her veracity. Eleanor Brassard 
could have seen no fever case, for her own is the first on the record in Sep- 
tember, and she never left the parade to run about the island. 

Case 9. — Private Francis Brassard, Company E, 2d Artillery, hard drinker, 
husband and father of the last two patients, was taken with severe fever, 
registered remittent, of a yellow fever character, on the afternoon of the 24th 
of September, He had intense supra-orbital pain, sufi"usion of the eyes, and 
slightly injected conjunctivse. Pain of back and limbs severe. Cal. x grs., 
and in three hours Ji ol. ricin ; x grs. c{uin. at tattoo, and same in the night. 
No. LV.— July 1854. 4 



46 Porter^ Climate, etc., of Fort 3IouIirie and Sullivan's Island. [July 

This case was trusted almost entirely to quinia. Duty on the 17th October. 
He was in Charleston last, for an hour or two hours only, on the 16th of 
September^ the day of the infant's death, or eighteen days before the attack 
of fever. Never slept in town. No member of this family saw a case of 
fever except their own sick. If Brassard had been taken with fever first, 
even eighteen days after having visited Charleston on the 6th of September, 
- it would be said that he imported the fever from town, and gave it to his 
daughter and wife. Instead of this, he was the very last of the family to 
suffer. 

Case 10. — Private John Hazeltine, Company K, 2d Artillery, was hospital 
attendant during the whole summer, the hospital being on the west side of 
the parade. Moderate drinker. Was attacked with remittent fever on the 
9th of September; duty on the 18th. He had not been in Charleston since 
the month of June. 

Case 11. — Sergeant William McNair, Company K, 2d Artillery, quarters 
on the west side of the parade, was taken on the sick report and admitted 
into hospital on the morning of the 11th of September, stating that he had 
been unwell since the 9th. There was no doubt of the nature of this case 
from the commencement. Was a hard drinker, and he stated to me that he 
had been drinking more than usual for a few days, on account of the severe 
duty and bad weather. On the 12th his condition was considered hazardous; 
very yellow ; stomach very irritable, which was relieved by sinapisms and a 
large blister to the epigastrium, and creasote mixture. Cal. grs. x, morph. J 
gr. at night. Quinia continued from the first, during the day and night. As 
he became convalescent, symptoms of nervous irritation began to show them- 
selves in a decided manner, which ended in mania a potil. He finally re- 
covered ; duty on the 20th October. That this was a case of yellow fever is 
certain ; for the intense pain of the frontal region and orbits, tenderness of the 
eyeballs, suffusion, and injected conjunctivae on the first day (11th), added to 
the yellowness and increased injection of the vessels of the conjunctivas on 
the 12th, leave no room for doubt. Indeed, there was almost every sign of 
yellow fever except the black vomit, and there was so much retching and 
vomiting on the 12th, that this was momentarily expected. This (on the llth) 
was the first case of undoubted yellow fever on Sullivan's Island, the case of 
Mary Ann Brassard (on the 15th) being the second. The patient was last in 
Charleston on the 1st of July, more than two months previous to the attack, 
and he had not left Sullivan's Island since that date ; there is, therefore, no 
doubt of his fever having originated on the island. 

Case 12. — Margaret McNair, wife of the sergeant above named, was taken 
with yellow fever on the 30th of September. Severe pains of the frontal and 
orbitar regions ; eyeballs very sore and tender to the touch ; suffusion ; vessels 
of the conjunctiva injected; severe pain of the back and limbs; stomach quiet, 
though some uneasiness at the epigastrium. Plas had three children, and is 
now six months enceinte. Sinapisms to the cervix and epigastrium ; cups to 
the mastoids and cervical spine : Cal. quin. aa grs. x.; ol. ricin. ^i, in two 
. hours; and grs. x quin. in four hours from the first dose. Morph. gr. J, at 
night, and the quinia was continued in smaller doses. No more calomel was 
given than the first dose, as fears were entertained that a tendency to miscarriage 
might be produced by it if persisted in, but the quinia was given pretty libe- 
rally until the morning of the 3d October, or nearly three full days from the 
attack. October 3. — Last night, at 9 and 3 o'clock, took quin. grs. x, and 
morphia J gr. 7 A. M. Patient free of fever; pulse soft and nearly natural; 
tongue moist ; no pain of the head ; eyes of nearly natural appearance ; very 



1854.] Porter, Climate, etc., of Fort Moultrie aiid Sullivan^ s LJand. 47 



yellow. Directed mild treatment, an enema, small doses of quinia, iced mu- 
cilage, a little beef tea, &c. Unfortunately, about 9 o'clock, A. M., unmis- 
takable labour pains began, slight but frequent convulsions came on, the 
patient became insensible, the head and forehead became hot and the skin 
drj, the ememhle rendering an unfavourable termination highly probable. In 
this state but little was attempted • iced mucilage, which she swallowed, was 
given in small quantities ; sinapisms were applied behind the ears and over 
the cervical spine, and afterwards "blisters ; and cloths wet in iced water were 
kept constantly applied to the forehead and whole head. At 2 o'clock P. M., 
the OS uteri was fully dilated, and the membranes ruptured, when the arm 
and shoulder immediately came down, but it was determined to do nothi'jg 
just at this stage, for the following reasons : The patient was much exhausted; 
she had borne children ; the pains were frequent and strong; pelvis ample; 
the soft parts were dilated, and easily dilatable ; and the child was not of full 
size. For these reasons, the case was, for the present, committed to nature. 
The left shoulder presented — the right cephalo-iliac position of M. Chailly, 
head to the right, back in front. In a short time the body of the child v>'as 
forced down by the strong pains, so that the hand nearly protruded from the 
vulva, when it was determined to render manual assistance ; and in the event 
of this proving unsuccessful, to resort to instruments without delay, by reason 
of the exhaustion of the patient. In the absence of a pain, the head was 
carried up to the right of the p^elvis as far as possible, bringing down the lower 
extremities; then assisting a strong pain with the fore and middle fingers, the 
body and lower extremities were delivered as far as the shoulders, and by the 
next pain, a very strong one, the head and placenta were delivered together. 
Fortunately, there was no hemorrhage. As the uteri became fully dilated, 
the convulsions ceased, the patient gradually recovered from the insensibility, 
and by the time that delivery was effected (about 4 P. 31.) she was quite 
sensible, though greatly exhausted, the pulse being very feeble. Two or three 
large doses of brandy and water were given, but this beginning to disagree 
with the stomach. Port wine and water was substituted, and a few drops of 
seth. sulph. were frequently given. 10 P. M. More comfortable than could 
have been anticipated; pulse has risen; stomach quiet. Continued the wine 
and water through the night in such quantity and strength as to suit the 
patient ; iced mucilage ; a little chicken-tea ; \ gr. morph. October 4. — Passed 
a comfortable night ; pulse firm. All the blisters drawn and dressed; omit 
wine; take small doses of quin. and a little beef-tea. Oct. 5. — Eeaction; 
pulse firm and frequent; hot skin; pain in the frontal region and eyes re- 
turned; irritability of the stomach, not excessive however. Cathartic enema; 
blister to epigastrium ; grs, x Cjuin. at 8, 12, and grs. v at 4 P. M. ; iced 
mucilage ; chicken tea in small C|uantities every two hours. Night. — Better. 
Pain of the frontal region and eyes abated, nearly gone, and in its place buz- 
zing of the ears (quininization) substituted ; pulse soft ; stomach quiet ; skin 
soft and cool ; and in every respect the patient is better. From this time she 
was put on small doses of cjuinia, mist, ammon. and camph., beef and chicken 
tea, &c. ; and the diet was gradually improved. Recovered. This patient 
had not been from Sullivan's Island for more than two months. 

How came Margaret McNair to have yellow fever ? In my opinion, by 
being exposed to the- very same causey which gave the disease to Mary Ann 
Brassard, for they resided on the same side of the parade, and their rooms 
were not twenty feet apart. Bat the contagionist will account for this case 



48 Porter, Climate^ etc., of Fort lloullrie and Sullivan's Island. [July 

of fever very differently; that she contracted it from her husband. Then, 
how came Sergeant McNair to have yellow fever ? Of whom did he contract 
the disease ? The learned Brahmin taught his disciples, that the earth rested 
on the back of a huge elephant, and that the elephant stood on the back of 
a huge tortoise ; and thus the whole matter was satisfactorily accounted for, 
the tortoise being left to support himself and burden in the best way he 
could. If yellow fever is contagious, why did not Margaret McNair's little 
daughter (six or seven years of age), who resided and slept in the same room 
with her mother during her whole sickness (these particular quarters having 
but one room), contract the disease ? Children are not liable to the disease, 
say many physicians. Not liable to the disease ! How can this be ? Why 
are not children aff'ected by the materies morhi of a malignant contagious 
fever, especially when exposed day and night, as this child was ? 

During Margaret McNair's illness and miscarriage, five persons were par- 
ticularly exposed — Ann Duffy, Mary Stolper, Eliza Craig, Catharine Connor, 
and Margaret Cooney. Ann Duffy was present least of all, and did less ser- 
vice than any of them; she had yellow fever on the 16th of October, and it 
may be said that she took the disease here. This is not my own opinion ; 
others, however, may think so. Mary Stolper (Case 6) assisted materially, 
and was present during a part of the labour, but beiug herself enceinte, I sent 
her away. After the delivery she returned, and rendered efl&cient assistance 
during the remainder of the afternoon, and the whole of the evening. Will 
it be said that the very slight case of fever reported was sufficient to protect 
M. Stolper from the contagion of malignant yellow fever ? If so, it equals 
vaccination for protection from variola. Eliza Craig, C. Connor, and M. 
Cooney rendered more assistance than all others, previous to, during, and 
subsequent to the miscarriage on the 3d of October, and were consequently 
pre-eminently exposed to contagion ; but not one of them had a symptom of 
yellow fever, or any other fever, during the whole year. Eliza Craig, wife 
of a drunken private, was much with this case, and also with Mary Ann 
Brassard and Deborah Doherty, whose case will be referred to; and Craig 
lived in the same block of quarters with Brassard and Doherty. These blocks 
are one-story wooden buildings, raised two or three feet from the ground, and 
each one of them contains three sets of quarters for married soldiers ; and 
Brassard, Craig, and Doherty lived in one block, Craig in the centre, and the 
other two families having yellow fever. Not one of the Craig family, hus- 
band, wife, and two children, had any kind of fever. C. Connor and M. 
. Cooney took ciire of the patient during the night of 3d October, and took 
good care of her. C. Connor was greatly exposed to yellow fever during the 
whole season. She lived in the same quarters with Brassard's wife during 
her severe illness, and assisted her, and afterwards was with M. McNair, as 
above stated. She had no fever. M. Cooney was with this case, as de- 
scribed. She lived with Ann Duffy, who had yellow fever, and took care of 
her during her sickness; nor was she ill a single day during the year. Ought 



1854.] Porter^ Climate, etc., of Fort Moultrie and Sullivan'' s Island. 49 

not these three persons to have contracted yellow fever, if it be contagious ? 
It may be supposed that they had suffered from yellow fever previously. If 
this had been the case, it would not have been a sure protection, though 
somewhat of a probable one. But it so happens that not one of them ever 
had yellow fever in their lives. 

Case 13. — Sarah McClure, Irish, living with a family on the west side of 
the parade, was taken with remittent fever on the 11th of September. Re- 
covered. This woman had not been from Sullivan's Island for more than a 
month. 

Case 14. — Deborah Duherty, wife of private John Doherty, Company K, 
2d Artillery, quarters on the west side of the parade, primipara, was deli- 
vered of twin children on the evening of the 7th of September. On the 12th 
September she was attacked with remittent fever of a mild character. Octo- 
ber 7, attacked with yellow fever, which proved not to be severe. Recovered, 
She had not been from Sullivan's Island for months, and Craig, whose family 
never had fever, lived between her and the Brassard family. Her state of 
health had been such, to my certain knowledge, as to prevent her from leaving 
her room for more than a month previous to her confinement, nor was she 
able to leave it until long after the 7th October. 

Case 15. — Private John Doherty, husband of the foregoing, temperate, 
and of good character, was taken with severe remittent fever on the 21st of 
September. He had not been from Sullivan's Island since the month of 
May. 

Cases 16, 17. — Henry Dounan, and Mary his wife, parents of Deborah 
Doherty, landed from an emigrant ship, after a six weeks' voyage from Ire- 
laud, on the 18th of September, both being unwell, and on the 20th they were 
quite ill with a sort of remittent, which soon became continued, and of a 
typhous character. Resided in Doherty's quarters after landing. Having 
had a long voyage without any comforts, in a crowded ship, and arriving in 
a filthy condition, more apprehension was felt in regard to contagion from 
these two persons than from all the rest of the sick put together, during the 
whole epidemic. But contagion was not present in these cases, more than^in 
those which originated on Sullivan's Island; for no other cases resembling 
them made their appearance. They were put on laxatives, moderate doses of 
cjuioia, and small doses of calomel ; and as soon as their mouths were touched 
(the man's mouth was not very sore, the woman had severe ptyalism) they 
were put on small doses of quinia, wine, brandy, ale, and a nourishing diet. 
They recovered. 

Case 18. — Thomas Williams, Ordnance Sergeant, was taken with remit- 
tent fever on the 14th of September. A mild case. Quarters on the west 
of the parade. Was in Charleston last eight days before the attack. Never 
stayed in the city over night. 

Case 19. — Private Charles W. Reudiger, Company K, 2d Artillery, hos- 
pital cook (the hospital is on the west side of the parade), was taken with 
remittent fever on the 16th of September. He had not been to town since 
June, to my certain knowledge. A mild case. Moderate drinker. 

Case 20. — Mary Madden, Irish, arrived at Charleston from New Bedford, 
Mass., on the 18th September, and on the 22d she was taken with mild remit- 
tent at Sergeant Duffy's, on the east side of the parade. Stayed over night 
,in Charleston on the 18th and 19th. A very mild case. 

Case 21. — Private William Connor, Company K, 2d Artillery, was taken 
with severe remittent fever on the 29th of September, The symptoms were 



50 Porter, Climate^ etc., of Fort Moultrie and Sullivan's Island. [July 

of the yellow fever type : intense supra-orbitar pains, tender eyeballs, suf- 
fusion, slight injection of the conjunctival vessels, &c. First day, 8 A. M., 
caL, quin., aa 10 grs.; ol. ricin. ^i at 11 A. M. ; 10 grs. quin. at 1 and 6 P. M. 
At 10 and 4, night, 5 grs. quiniaj J gr. morphia at 10. The treatment 
afterwards was principally with laxatives, and quinia in smaller doses, until 
convalescence. Connor was married on the 15th of August, and remained 
in the fort until the 1st of September, when he stayed at night with his wife 
(Catharine Connor, before mentioned) on the west side of the parade, at the 
quarters of Brassard, as stated. Connor never left Sullivan's Island after his 
marriage on the 15th of August, until the 28th of September, the day before 
he was taken sick, and the day that Major Koland died of yellow fever at 
Castle Pinckney, when he was sent to Charleston for a short time, an hour 
or two only, on duty. Sober ; conduct correct. In addition to her exposures 
to yellow fever already related, Catharine Connor visited her husband daily 
in the hospital during his illness, at a time when there was plenty of the dis- 
ease, for Connor did not return to duty until the 17th October; and between 
the 4th and 12th October, inclusive, there were thirteen cases of real yellow 
fever admitted. Ought not this woman to have had yellow fever ? 

Case 22. — George Whiteside, discharged sergeant of the 2d Artillery; 
drunkard ; quarters on the west side of the parade in a building pertaining 
to the hospital — his wife being hospital matron — was taken sick with severe 
remittent fever on the 30th September. Calomel, ol. ricini, and quinia on 
the first day ; mainl}^ quinia on the second and third days. As the fever 
gave way, his mind wandered ; symptoms of delirium tremens commenced 
on the 3d of October, and on the 4th the disease was established. Opium, 
morphia, camphor, brandy, &c. were given without effect. October 5, the 
patient was so violent as to require the strait-jacket for a short time this 
morning. Cal. 10 grs., opii gr. at 8 A. M. ; chloroform ^ drm. (internally), 
well diluted, at 10 A. M., and repeat at 12 M. No effect.^ At 2 P. M. gave 
a drm. of sulphuric ether, to take ten drops of it every half hour until 
4 P. M., when another drm. is to be given. He took the first ten drops at 
2 J o'clock, fell asleep before 3 P. M., and did not wake until after dark. 
Convalescent from this time; small doses of ether during the night. Octo- 
ber* 6 — ten drops ether hourly; nourishing diet;, same at night every four 
hours. October 7 — same ; out of danger. This man was in Charleston on 
the 4th of September, and for the last time on the 15th. Never stayed in 
Charleston at night. 

We have noticed every case of fever which occurred on the parade in the 
month of September, and will now proceed to the fort. 

Case 23. — Daniel Meek, Company K, 2d Artillery, drunkard, was- taken 
with remittent fever on the 9th September. A very slight case; was not 
sick with fever again during the year. 

Case 24. — Sergeant Charles Seyfried, Company E, 2d Artillery, was taken 
with remittent fever on the 10th of September. Not a severe case ; duty on 
the 15th; sober. 

Case 25. — Private John De Goy, Company E, 2d Artillery, a great 
drunkard, was taken with remittent fever on the 12th September. Not a 
severe case. De Goy was post-baker until taken sick, and slept in the bake- 
house, on the west of the parade, and he ought to have been put in the 
other class of cases. 

Case 26. — James Gallagher, artificer, Company K, 2d Artillery, great 



1854.] Porter, Climate, etc., of Fort Moultrie and Sullivan's Island. 51 



drunkard, was taken with remittent fever on the 12th September. Not a 
severe case. 

Case 27. — Private George Hepp, sober, who had fever in August (see Case 
3), was taken with remittent fever on the 17th September. A pretty severe 
case. 

Case 28. — Private John P. Emmerson, Company K, 2d Artillery, sober, 
was taken with remittent fever on the 17th September. This was a smart 
case of fever. He had not been to Charleston for more than a month. 

Case 29. — Private Vincent Bazelte, Company K, 2d Artillery, sober, was 
taken with remittent fever on the 21st September. Severe case. Was in 
town last in June. 

Case 30. — Private John Roberts, drunkard, sick before (see Case 4), was 
taken with remittent fever on the 25th September. Not a severe case. 

Case 31. — Musician Thomas Banks, Company E, 2d Artillery, was taken 
with remittent fever on the 25th September. This was not a severe case. 
Drinker ; irregular in his habits. 

Case 32. — Private Edward Murrican, Company K, 2d Artillery, sober, 
and an excellent hospital attendant from the 9th September, was taken with 
severe remittent fever on the 26th September. Eight A. M., grs. x cal. ; 
J oz. ol. ricin. at 11 A. M.; grs. x quin. at 1 — 5 P. M., and same at 12 
o'clock, night. Sept. 27.— Quin. grs. v at 9, 12, 4, Q; and the case was 
entrusted almost entirely to quinia from this date. This case put on the yel- 
low fever type, for there was severe supra-orbital pain and suffused eyes. He 
had not been to Charleston since the month of July. 

Case 33. — Private George Tappey, Company E, 2d Artillery, was taken 
with plain remittent^ fever on the 26th September. Sober and correct. He 
was last in Charleston in the month of May. 

Case 34. — Private William Foster, Company E, 2d Artillery, was taken 
with remittent fever on the 27th September. Very mild case. Moderate 
drinker. 

Case 35. — Musician Wm. Stage, Company K, sober, was taken with re- 
mittent fever on the 29th of September. Quite a mild case. Though not a 
drunkard, of irregular habits. 

Case 36. — Brevet Major A , stationed at Castle Pinckney, was attacked 

with remittent fever at Fort Moultrie, on the 28th of September. He came 
from the Castle several days previous to the attack. Not a severe case. 

Case 37. — Private Peter M. Pilgrim, Company K, 2d Artillery, a notori- 
ous drunkard, was taken into hospital on the 20th of September, on account 
of severe contusions which he received while in a state of beastly intoxication. 
He remained in the hospital until the 27th of September, when he was attacked 
with severe remittent fever. Had not been in Charleston since the middle of 
August. 

Case 38. — Patrick, Irish boy, 11 or 12 years of age, servant to the officer's 
mess in the fort, was taken with well-marked remittent fever in the first part 
of September, date not put down with the other circumstances of the case. 
He had been in the habit of going to Charleston to see his parents, and often 
stayed over night, in the upper part of the city, in the vicinity of ponds and 
marshes. 

We will now briefly view those cases which' were wholly unconnected with 
the fort and parade in the month of September. 

Cases 39, 40, 41, 42. — xilmost the entire family of Capt. Elzey, 2d Ar- 
tillery, residing on Cove Street, entirely detached from the fort, was sick with 



52 Porter, Climate, etc., of Fort 3Ioultrie and Sullivan^ s Inland. [July 

fever in the rnontla of September. One lady, two white female servants, and 
one coloured female servant, had smart attacks of remittent fever, and not 
one of them had been from Charleston in a long time. As it will not be ne- 
cessary to notice the fever in this family again, we will give three Cases, 43, 
44, and 45, all occurring in the month of October. One lady was the subject 
of a trifling remittent; and one coloured servant and her child, who spent the 
day at the family residence and slept in a neighbouring house, had smart 
attacks of the same fever. The lady had not been in town for some time 
previous, and the two servants had not been from the island during the sum- 
rjer. 

Case 46. — Capt. Elzey was taken sick with severe fever on the 30th of 
September, after inspection, registered remittent, it being of that type, though 
it might have been termed yellow fever; for there was intense supra-orbitar 
pain ; the eyes had an unnatural appearance, were very tender on slight pres- 
sure, sutfused, and the vessels of the conjunctivae were injected. He was 
taken with chilliness, but did not have a confirmed chill, and there was a 
tendency to remission towards morning during the whole fever. In the pro- 
gress of the disease there was a very dusky hue of the. face, and the forehead 
was slightly yellow. Severe pain of the back and limbs. Had a severe attack 
of jaundice in July ; has been quite healthy since. Cups to back of neck ; 
grs. X quin. ; ^i ol. ricin. in two hours; grs. v quin. every four hours from 
the first dose. No mercurial was given in the whole course of the fever, as 
the smallest quantity would produce ptyalism, and it was held in reserve in 
the event of absolute necessity. It was found that five grs. of quinia was 
about the maximum dose, ten grs. producing ringing in the ears, severe pain 
in the occipital region, and other nervous irritation. Even the five grs. had 
often to be omitted at night. During the progress of the disease there was a 
good deal of restlessness, requiring morphia at night; and on the evening of 
the fifth day there was so much nervous irritation that the following was 
necessary : Sulph. morph. J gr. ; camph. 3 grs.; tart. ant. J gr. ; in pills at 
one dose. To this 2 or 3 grs. calomel would have been added had it not been 
for the idiosyncrasy; but the prescription procured sleep and a comfortable 
night, and the next morning the patient was better. From this time con- 
valescence commenced. Capt. E. had not been to Charleston for three weeks; 
and he thinks the fever was brought on by exposure to wet while gunning 
on Sullivan's Island, in which opinion he is doubtless correct. 

The immediate cause of fever in this family seems to be obvious. The rain 
fell in torrents in the first part of September, and the whole island was nearly 
covered with water; the kitchen, in the house, had a floor of boards placed 
directly on the ground, and for a few days the water was so deep on this 
floor, I was informed by a member of the family, as to render it almost im- 
possible for the servants to prepare the regular meals ; and the floors of the 
servants' lodging-rooms, adjoining the kitchen, were made of brick, the most 
•improper of ail materials in a humid atmosphere. No floor ought to be con- 
structed of brick unless previously dipped in boiling pitch or asphaltum. No 
person ought, in truth, to have occupied the lower floor, and the whole of this 
house was rendered insalubrious by excessive dampness. Is it surprising that 
fever should occur in such circumstances ? Would it not have been very sur- 
prising if the family had continued healthy ? 



1854.] Porter, Climate^ etc., of Fort Moultrie and Sullivan's Island. 53 

Case 47. — ^Irs. C, wife of J. C, residing on Middle Street, between the 
fort and hotel, has had three children, miscarried (at about three months) in 
the first days of August, was taken sick with yellow fever on the 23d of Sep- 
tember. Was ^' regular" just two weeks before. Profuse uterine hemorrhage 
occurred on the 29th, which lasted four days. This is unusual; states that 
the. regular period lasts only a few hours ; and that this is very unusual in 
quantity, appearance, duration, and in all the symptoms. At my first visit 
the patient had intense supra-orbital pain ; eyes changed, unnatural in appear- 
ance, tender on slight pressure, sufi*used, and the conjunctival vessels were 
injected ; intense pain of the back and limbs ; and after a few days, yellow- 
ness of the face and neck. Took calomel, quinia, and ol. ricini on the first 
day, and the quinia was afterwards continued. An unfortunate accident com- 
plicated the case early in the disease : A solution of quinia was left at night, 
one-half to be taken at 12 o'clock, but a bottle of Eau de Cologne was un- 
fortunately mistaken by the nurse for the quinia bottle. This harsh dose 
created much irritation of the stomach, but the offending cause was fortu- 
nately soon expelled ; the supervening gastric symptoms, however, were severe, 
irritability, pain and tenderness of the epigastrium, dry tongue with red edges, 
&c. Sinapisms, cups, and blisters to the epigastrium ; enemata and mild laxa- 
tives; moderate doses of quinia with small quantities of calomel and ice, and 
iced drinks were employed. The mouth became a little sore, and the patient 
became convalescent. She had been in the habit of visiting Charleston fre- 
quently, as often as two or three times a week, but had not stayed there all 
night since the June previous. 

We have ^ome to the end of September, and have noticed almost every 
case of fever pertaining to the garrison, every one of importance in the month. 
Let it be recollected that the night of September 30th is completed; that our 
garrison consisted of Companies E and K, 2d Artillery, during the whole 
quarter which is now ended ; that few or no changes took place in the quarter; 
that no communication had taken place between the posts of Fort Moultrie 
and Castle Pinckney, for no communication between the sick and well of the 
two posts could take place; that none of our really sick patients had been ex- 
posed in Charleston, or at Castle Pinckney; and that the movements of all 
persons who were severely sick could be traced for days and weeks previous 
to the attack of fever. We will throw out every doubtful case, and we have 
remaining 27 cases of fever, 24 of continued and remittent, and 3 of yellow 
fever, which originated on Sullivan's Island. A strict contagionist may con- 
tend that Margaret McNair contracted yellow fever of her husband ; we will 
throw this case out, though we believe no such thing, and we have 2 un- 
doubted cases of yellow fever, and 24 cases of other fever, 26 cases in all, 
without the suspicion of importation or contagion. These cases originated on 
Sullivan's Island under such circumstances as leave no manner of doubt in 
relation to their origin. Not one of them had been exposed to any cause of 
fever except on Sullivan's Island. 

It has been said that the garrison of Castle Pinckney introduced the con- 
tagion of yellow fever into the garrison of Fort Moultrie. We will examine 
the facts. Let us see whether the garrison of Castle Pinckney had the con- 



54 Porter, Climate, etc., of Fort Moultrie and Sullivan's Inland. [July 

tagion to introduce so early as the 11 th and 15th of September. The garri- 
son of Castle Pinckney was not withdrawn to Fort Moultrie until the first day 
of October, and up to this date there was little communication between the 
two posts, for a man on pass had no inducement to visit the dull and dreary 
post of Castle Pinckney. In truth, there had been little sickness at Castle 
Pinckney when that post was abandoned, for Major Roland's death did not 
take place until the 28th of September, after an illness of three or four days 
only, of yellow fever contracted in Charleston; and Capt. Allen was taken 
sick after the funeral of Major R. (which was on the 29th), and left behind 
when the garrison withdrew to Fort Moultrie. The cases of these two officers 
were the only cases of yellow fever up to the 1st of October ; whereas, at 
Fort Moultrie there w.ere two cases of yellow fever and abundance of southern 
bilious fever before Major Rowland was attacked, and before there was a 
single case at Castle Pinckney; and before the garrison of that post came 
over, there had been at Fort Moultrie 3 undoubted cases of yellow fever, and 
39 cases of bilious fever — 42 cases in all, in the month of September — ten- 
fold more sickness than at Castle Pinckney. Not a single sick person, man, 
woman, or child, came from the Castle on the 1st of October, and only one 
sick person (Capt. Allen) was left behind. Up to the removal, the garrison 
of Castle Pinckney was decidedly more healthy than that of Fort Moultrie. 

It has been said that the yellow fever was brought from Charleston. This 
is not the fact. Only a certain class of men apply frequently for passes to 
town ; the married, sober, and steady men rarely ask for passes, nor do the 
drunkards get them, or often apply for them, for there are groggeries enough 
on Sullivan's Island. Further, all classes were aware of the great sickness in 
town, and night passes were refused. So early as July 24th, the following 
communication was made to the officer in command: — 

" The heat of the weather, the filthy condition of the streets of Charleston, 
and the reports in relation to present disease there, render it advisable, in my 
opinion, for us all to be on the safe side of the question ; and I would therefore 
request the Colonel commanding to consider the expediency of refusing per- 
mission to all persons composing the garrison of this post to pass a single night 
in the city." 

Not one of the Fort Moultrie cases in September had been to Charleston 
(see Cases 8, 11, 12) for weeks, and not one of them saw a case of yellow 
fever except in their own families. In all September, there had been four 
cases of yellow fever unconnected with the fort. Mr. Kennedy, who died at 
the Moultrie House on the 23d of September, after an illness of five days ; 
the bookkeeper of that hotel, who was at the crisis of the disease on the day 
of Kennedy's death ; Mr. Ferguson, who died at the steamboat landing near 
the date of Kennedy's death; and Mrs.€. (Case 47.) These particulars can 
be relied on. These four patients could not possibly have introduced the 
yellow fever into our garrison, for the best of all reasons — we had it first ; 
two of the cases (8, 11) being the very first cases on the island, and the third 



1854.] Porter, Climate^ etc., of Fort Moultrie and Sullivan's Idand. 55 



(No. 12) could not possibly have been exposed to any one with the disease 
except at the fort. The conclusion is irresistible, that yellow fever was not 
introduced from Castle Pinckney, nor from Charleston, but that it originated 
on Sullivan's Island. 

Octoher 1. The garrison of Castle Pinckney was removed to Fort Moultrie, 
and from this date our garrison consisted of Companies E, K, M, all of the 
2d Artillery. It is a curious fact in the history of the soldier, that no move- 
ment of troops can be made without a big drunk," in spite of the officers ; 
and never was a custom more " honored in the observance" than by Company 
M ) for during the first four or five days after the removal there was scarcely 
a sober man in the company; and the disease was as contagious as Sir William 
Pym represents yellow fever to be, for almost every man in Companies E and 
K had an attack, contracted of Company M. This was the only contagious 
disease introduced from Castle Pinckney during the year. 

Octoher 2. One case of remittent fever from Company E; 4th, two cases 
of yellow fever from M; 5th, one case of remittent fever from E; one case 
of yellow fever from M; 7th, one case of yellow fever from K; 8th, one 
case of yellow fever from K; 9th, one case of yellow fever from K, and one 
from M; 10th, one case of yellow fever from M; 11th, one case of yellow 
fever from E, two from K, and one from M ; 12th, one case of yellow, and 
one of remittent from M ; 13th, one case of yellow fever from M; 14th, one 
case of yellow fever from K, two from M ; 16th, one case of yellow fever 
from M; 17th, one case of yellow fever from E, one from M; 19th, one 
yellow fever from K, two from M; 20th, one yellow fever from M; 23d, 
one yellow fever from M; 25th, one case of yellow from K; 26th, one from 
K; 28th, one from K; 31st, one case of yellow from Ordnance Corps. 

November 4. Two cases of yellow fever from M; 10th, one case of yellow 
fever from K; 16th, one case in the field and staff, remittent, the end of the 
epidemic, there having been severe frost on the morning of the 15th. 

Some of the most interesting after the 1st of October will be given, divided 
into the same classes as in September — those on the parade, those in the 
fort, and those entirely detached from the fort. 

Case 48. — Bridget Whiteside, wife of Case 22, hospital matron, quarters 
' on the west side of the parade, was delivered of a healthy child on the 27th 
of September, and seven days after, on the 4th of October, she had an attack 
of remittent fever, from which she recovered without difficulty. This patient 
had not been in Charleston for months, and I am certain that she had not 
been able to leave her room for many days previous to her confinement. 

Case 49. — Deborah Doherty, taken with yellow fever Oct. 7. See Case 14. 

Case 50. — Alexander McDonald, native of Scotland, clerk, on the east 
side of the parade, was taken with remittent fever on the 15th of October. 
This was a light case. He had not been to Charleston for many weeks ; 
being a comparative stranger, I advised him to cautiously avoid town during 
the epidemic, and on the island he saw no sick person. In the month of 
June previous, he had a severe attack of bilious colic. He left Glasgow in 
a packet ship on the 1st September, 1851, and arrived in New York on the 



56 Voiier, Climate, etc., of Fort Moultrie and SuUic art s lihj^^^ [July 



21st of the same montli. Arrived in Charleston in the last part of October, 
stayed there about eight days, and came to Sullivan's Island on the 6th of 
November. He did not leave the island from that date, and was taken sick 
with bilious continued fever, of a typhoid type, in the last part of December. 
This was a severe case, and at one time a fatal termination was feared ; pulse 
frequent, but sometimes full, slow, and occasionally losing a beat; skin hot 
and dry, the heat sometimes amounting to cahr morcUcans; tenderness of the 
epigastrium and meteorismus; very brown and dry tongue; heavy sleep, 
sometimes approaching to lethargy, &c. This case had to be treated more 
like the typhoid fever of the north than most southern fevers. Quinia was 
of no use, though tried at the beginning of the disease, and after a small 
quantity of calomel at the commencement, and cups to the cervical spine and 
epigastrium; small and frequent doses ammon. acet., with a little spts. eth. 
nitros. ; minute doses of ipecac, mild laxatives and enemata, epispastics, mild 
nourishment, &c. were^ relied upon. He was not able to resume business 
before the month of February; and he has never recovered the ruddy com- 
plexion with which he aiiived from Scotland, but presents the sallow face of 
a southern resident. He is temperate, and exemplary in his conduct in every 
respect; and he has since stated to me that he cannot account for this fever; 
that he saw no sick person ; that he did not go out at night or in the even- 
ing, and that he never lived more prudently in his life. The year 1851 was 
healthy, there being but few cases of climatic disease ; but in the autumn and 
first part of winter, fevers and dysentery assumed a typhoid character, the 
same type of disease prevailing at the time in Charleston, as I was informed 
by some of the physicians. The fever of 1851, and subsequent bilious colic, 
probably saved our patient from the yellow fever of 1852. 

Case 51. — Ann Duffy, wife of Sergeant Duffy (Case 5), on the east of the 
parade, was taken with yellow fever on the 16th of October. Has no children, 
and the catamenial discharge has always been scanty. Had ended a regular 
period two days before. AYas attacked with fever about 3 o'clock A. 31., and 
I saw her at 7 A. 31. She had intense pain in the frontal and orbiiar re- 
gions; eyes tender, suffused, and the vessels injected; severe pain in the back 
and limbs; dusky appearance of the skin (is a brunette); stomach quiet. 
Quin., cal., aa 10 grs. ; 1 oz. ol. ricin. at 10 A. 3L; quin. 10 grs., cal. 5 grs. 
at 12 31.; at 5 P. 31. 10 grs. quin. and 3 grs. cal.; and 3 grs. cal., 10 grs. 
quin., and \ gr. morphia at 10 P. 31. Take 10 grs. quin. at -4 o'clock to- 
morrow morning. 11th. Pain of head and eyes relieved, and appears much 
better; no more calomel was given; five-grain doses of quinia every four 
hours. 18^/i. Face and neck yellow; profuse uterine hemorrhage, which 
continued until the 30th, though in less quantity than at first. Slight hemor- 
rhage from the mouth and throat; no ptyalism ; recovered. AYas last in 
town on the 24:th of August. See Case 5, 

3Iargaret Cooney, mentioned before, nursed this patient, and it appears to 
me that she ought to have contracted the disease, having been repeatedly 
exposed to tlie contagion. 3Iary 3Iadden, Case 20, was with Ann Duffy 
during the whole fever, and slept in the same room with her ; did her slight 
remittent fever preserve her from the contagion of yellow fever? 

Case 52. — James Quinn, first Sergeant of Company E, sober, conduct 
unexceptionable, quarters on the east of the parade, was taken with yellow 
fever on the 17th of October. This case was at first treated with quinia and 
a small quantity of calomel, sinapisms, and cups to the epigastrium, laxa- 



1854.] Porter, Climate, etc., of Fort Moultrie and Sullivan's Lland. 57 

tives, &c., and the fever was considered as broken up; but a reaction or 
secondary fever came on on the 24th, and it was found necessary to adopt a 
more decisive course ; the patient was therefore put upon quinia and calomel, 
epispastics to epigastrium and over the cervical spine; brandy was given 
according to the taste ; beef tea, chicken broth, &c. The fever did not give 
way until the mouth became sore, which could not be effected until the 29th. 
He was then put upon small doses of quinia, anodynes at night, the brandy 
was continued, nourishing diet given, and he went to duty on the 2od of 
November. He had not been from Sullivan's Island since the 26th of 
August. 

In this family there were five persons besides the sergeant — Sergeant 
Quinn's wife, the oldest boy, aged sixteen, and three other children of various 
ages. The mother had yellow fever in Charleston a few years before, which 
may perhaps be considered sufficient protection to her, and children are not 
so susceptible to yellow fever as adults; but the eldest son can scarcely be 
considered as under the protection of childhood. ' 

Case 53. — James Winnie, eight years of age, son of artificer Winnie, 
Company M, quarters on the west side of the parade, came from Castle Pinck- 
ney with the garrison on the 1st of October, and on the 18th of the same 
month he was taken with remittent fever. The case was not severe. While 
Company M, from Castle Pinckney, had already suffered severely from yellow 
fever, brought on by drunkenness and other causes, it is a curious fact that 
this was the very first fever, of any kind, which had attacked any woman, 
child, or servant from that post, the original garrison of Fort Moultrie, men, 
women, children, and servants, having suffered severely from febrile diseases 
during the whole of September, and to this very day. Not one of the non- 
military from Castle Pinckney suffered from an attack of fever until the 18th 
of October, eighteen days after removing to Fort Moultrie. This patient did 
not leave Sullivan's Island after the 1st of October. 

Case 54. — John Riley, about eighteen months old, son of Sergeant Riley, 
M, quarters on the east of the parade, was taken with remittent fever on 
the 19th of October. This was the second case belonging to the non-military 
from Castle Pinckney. Had not been from Sullivan's Island since the 1st 
of October, the day he came from the Castle. This child had a lighter attack 
of the same fever on the 2d of November. 

Case 55. — Bridget Tighe, about twenty-five years of age, living in Ser- 
geant Riley^s family, was taken with yellow fever, twenty-two days after her 
arrival from Castle Pinckney. Had not been from Sullivan's Island since the 
1st of October. She was put on calomel and quinia until the gums were 
made somewhat sore, when she recovered without difficulty. Sergeant Riley 
had but one room for quarters during the epidemic; the family cooked there, 
ate there, slept there, and Bridget went through yellow fever there; yet both 
the Sergeant and his wife escaped every kind of disease. How could this 
be, if yellow fever is contagious? for every member of the family was re- 
ceiving the materies morhi into the stomach and lungs, both day and night, 
during the progress of Bridget's case. That the woman had yellow fever 
there is no doubt, for the intense supra-orbitar pain, suffusion, injected con- 
junctival vessels, and yellow face and neck, all seem sufficient to establish 
that fact. 

Case 56. — Mary Ann Winnie, mother of Case 53, wife of artificer Win- "~ 
nie, was taken with yellow fever on the 26th of October, twenty-six days after 



58 Porterj Climate, etc., of Fort 3IouItne and SuIlivan^s Island. [July 



tke removal from Castle Pinckney. Had not been from Sullivan's Island 
since her arrival on the 1st. There was intense pain of the frontal and orbitar 
regions; the eyes were painful, tender, suffused, and the conjunctival vessels 
were highly injected; tenderness of the epigastrium. She was immedia^tely 
put upon calomel and quinia; cups to the cervical spine and epigastrium, and 
subsequently blisters, &c. Ptyalism was produced as soon as possible, this 
being the intention from the beginning on account of the severity of the 
attack. She finally recovered under the use of small doses of quinia, brandy, 
wine whey, mist, ammon. carb., anodynes, nourishing diet, &c. Winnie did 
not contract the disease, for he had no fever during the year. 

Case 57. — William Winnie, infant son of the above, was taken with remit- 
tent fever on the 2d of November, a month after arriving here from Castle 
Pinckney. Had not been from Sullivan's Island since the 1st October. 

We have thus given a brief history of every interesting case on the parade, 
including every person among women and children from the castle who had 
fever; and we find that 5 cases, 3 of remittent and 2 of yellow, occurred among 
9 persons who came from that post, not a single case occurring among them 
until 18 days after their arrival. We will give a few interesting cases from 
the fort. 

Case 58. — Charles Piatt, 1st sergeant of company M, sober as regards spi- 
rituous liquors, but an habitual opium-taker, was admitted into the hospital on 
the morning of the 5th of October, at 8 A. M. Had not reported before, and 
had entirely passed the first stage of the disease; very yell<)w; eyes yellow and 
injected; skin clammy; pulse slow and feeble, &c. Black vomit came on at 
12 M. on the 6th, and he died early on the morning of the 8th. After an- 
nouncing his death to the commanding officer, the communication goes on as 
follows: — 

"Sergeant Piatt, it is said, had been ill two or three days before reporting to 
the surgeon of the post, but there is certainly no doubt of his having been hard 
sick more than 24 hours before reporting. In yellow fever, more than in any 
other disease, three, four, five, or six hours at the outset are of immense conse- 
quence ; and no man with yellow fever can expect to recover after 24 hours' delay. 
The undersigned therefore respectfully requests all company ofi&cers to endea- 
vour, by every means in their power, to impress this important fact on the mind 
of every person connected with the command. Let every person pertaining to 
garrison, man, woman, and child, be reported without delay to the surgeon as 
soon as taken ill.'' 

This communication was published to the command on parade, with excel- 
lent effect. 

Case 59. — Private Fred. Schmidt, M, was taken sick with yellow fever on 
the 10th of October. He was a drunkard, a prisoner, and was admitted from 
the guard-house at 6 P. M. This case was managed in the usual manner, by 
sinapisms, cups, calomel, quinia, &c., and the mouth became sore on the 14th; 
and from this date convalescence seemed to be established, the patient taking 
little medicine except a bitter infusion, the diet being nourishing, as the appe- 
tite was rather strong. Indeed, the man was considered out of all danger. On 
the morning of the 20th, there were strong yellow fever signs, black vomit 
finally commenced on the 25th, and the patient lingered, in an ofi"ensive con- 
dition, and more dead than alive, until the 2d of November. There was 
mystery in this relapse, which at first could not be understood ; but the facts 



1854.] Porter, Climate, etc., of Fort 3IouItrie and Sullivan'' s Lland. 59 

finally came out. It is the custom among soldiers to "cheat the doctor/' if 
possible; and the patient had managed, by means of his confreres, to smuggle 
some liquor and a free diet into the hospital, thus "cheating the doctor/' and 
launching himself into eternity. 

Case 60. — Private Thomas Patterson, K, drunkard, was taken with yellow 
fever on the 11th of October. At 8 A. M., cal. 10 grs., opii J gr. ; 15 grs. 
quin. at 8, 12, and 4; ol. ricin. J oz. at 12. Quin., in smaller doses, at night, 
and on the 12th, 13th, and 14th. ' Appeared better on the 12th, decidedly 
better on the 13th, was considered convalescent on the 14th, and decidedly so 
< on the 15th. Took no medicine on the 15th and 16th, except" some bitter 
infusion, and his diet consisted of beef-tea in the day and arrowroot at night. 
Took no medicine on the 17th and 18th. 

18^/i — night. On making an evening visit to the hospital, found the patient 
had relapsed, or secondary fever had come on ; there was intense pain in the 
frontal and orbitar regions; eyes suffused, painful, tender, and the vessels were 
injected. Sinapisms and mustard pediluvia. Quin. 10 grs., cal. 3 grs., at 9, 
1, and 5 A. M. to-morrow morning, l^th. Quin. 5 grs., cal. 1 gr., at 9, 12, 
3, and 6; ol. ricin. 1 oz. Night. Quin. 5 grs., cal. 1 gr., at 9, 1, and 5; \ 
gr. morphia at 9. 20^^. Symptoms continue much as at first; very yellow. 
Quin. 10 grs., cal. 1 gr., at 9, 1, and 6. Night. Quin. 5 grs , at 9, 1, and 5; 
cal. 3 grs., morphia \ gr., at 9. 21st. 01. ricin. ^ oz., quin. 5 grs., at 9, 12, 
3, and 6. Night. Quin. 10 grs., cal. 2 grs., at 9, 1, and 5. 22<:/. Quin. 10 
grs., cal. 1 gr., at 9, 1, and 5. Night. Quin., cal., aa 5 grs., at 9; 10 grs. 
quin. at 1 and 5. 23f?. Quin. 5 grs., at 9, 12, 3, and 6; and 5 grs. cal. at 6. 
Niyht. Quin. 5 grs., cal. 2 grs., at 9, 12, 3, and 6. Wine and water, or ale. 
24^7i. Quin. 5 grs., cal. 2 grs., at 9, 12, 3, and 6. Brandy or wine, and beef- 
tea. Night. Quin. 3 grs., at 9, 1, and 5, and wine or brandy, as he prefers. 
25/7l Hitherto, no effect of the mercurial on the gums could be perceived, but 
this morning they were tender, with fetor of the breath. Quin., as yesterday, 
wine, chicken-tea. Night. Quin. 5 grs., at 9, 1, and 5; cal. 2 grs., at 9, to 
insure the effect. Brandy or wine. 2Qth. The patient was so ill that it was 
determined to continue the mercurial to the full extent of decided ptyalism. 
Quin. 5 grs., cal. 1 gr., at 9, 12, 3, and 6; J gr. opium at 9. Brandy or 
wine, and a little beef-tea. Night. Wine; opium 5 grs., cal. 1 gr., at 9, 1, 
and 5, and ^ gr. opium at 9. 21th. Mouth quite sore, and mercurials were 
omitted from this date. Grargles, wine and brandy, beef-tea, and 3 grs. quin. 
every third hour. With occasional variations, this plan was continued until 
the patient became thoroughly convalescent. Duty on the 27th of November. 
This was an exceedingly obstinate case, and perhaps the mercurial ought to 
have been pushed further in the first instance. 

Case 61. — Private Robert Ripley, E, a great drunkard, belonging to the 
guard of Fort Sumter, was admitted into hospital from that post on the 11th 
of October. He had been sick more than 24 hours, and would have been 
brought over on the 10th, but the high wind of the night before had damaged 
the boats so that it was impossible to get him into the hospital sooner. Eyes 
suffused and injected; face of a dusky yellow, his complexion being very 
swarthy; skin clammy. Mustard bath,^ sinapisms and cups to the epigastrium 
and thorax, quin. 10 grs., cal. 5 grs., at 9, 1, and 5. After this date he was 

* Baths and pediluvia have not been mentioned heretofore, because it is a standing 
hospital regulation that every patient shall be washed on admission, have his feet 
bathed, his clothes changed, and his hair combed and brushed — to be cut, if necessary. 
During the epidemic, the water for washing was always warmed, and the pediluvia 
contained mustard. 



60 Porter^ Climate, etc., of Fort Moultrie and Sullivan's Island. [July 



put on moderate doses of quinia, brandy, cliicken and beef-tea, &c. Duty on 
the 8th of November. This was the only case of fever at Fort Sumter during 
the season, and the occurrence of this was at first alarming, for we had fears 
that the yellow fever was breaking out there; but, on the other hand, the 
patient was known to be very irregular in his habits, and to have spent much 
time on Sullivan's Island; and finally, at the close of the epidemic, this proved 
to be the only case of fever which occurred there. In truth, the only healthy 
spot in the vicinity of Charleston, free from all fever during the year, was Fort 
Sumter. There were at this post during the epidemic, one ordnance sergeant, 
six privates, two women, and four children, thirteen persons in all, and not one 
of them had fever except Ripley. This man had yellow fever, and was nursed 
at Fort Sumter more than 24 hours; some one must have been exposed in that 
' time, for not one of these persons had ever been through the disease, yet no 
one contracted the fever. Further, I have reason to know, and do know, that 
the sergeant and six men were exposed, and not one of these seven persons 
received the contagion of yellow fever. 

Case 62. — Private Patrick Fitzpatrick, M, a great drunkard, was admitted 
into hospital on the 11th of October, at 3 o'clock P.M., with yellow fever. 
Cal. 5 grs., quin. 10 grs., at 3 and 7. JSfiglit. Same at 12, and 6 to-morrow 
morning. Large sinapisms and cups to epigastrium, blister to back of neck. 
11th. Quin. 5 grs., at 9, 12, 3, and 6; same at night, at 9, 1, and 5; cal. 5 
grs., sul. morph. \ gr., at 9. 13^A. Quin. 5 grs., cal. 3 grs., at 9, 12, 3, and 
6; sinapism, cups, and blister to epigastrium; enema. Night. Quin. 5 grs., 
at 9, 1, and 5; J gr. morph. at 9. 14:th. Quin. 5 grs., at 9, 12, 3, and 6; 
chicken-tea; same at night. Ibth. Continue quin.; large blister again to epi- 
gastrium; ol. ricin. 1 oz. Quin. every 4 hours at night. IQth. Much better, 
and appears convalescent. Continue the quinia. Vlth. Appears decidedly 
convalescent. Quin. 3 grs., with bitter infusion, every 4 hours. I'^th. Still 
better. Take same as yesterday, and 1 oz. ol. ricin, as the bowels had not 
moved for 24 hours. In the afternoon, I found him much worse, and with 
decided symptoms of yellow fever. Oil had not operated; enema. Quin., 
cal, aa 10 grs., at 5 and 9, and 10 grs. quin. at 1 and 5, night. 19^/i. Cal., 
quin., aa 10 grs., at 8 and 12; ol. ricin. 1 oz., at 2 P.M., as the bowels are 
somewhat confined; 10 grs. quin, at 6 P. M. Night. Cal., quin., aa 5 grs., 
morphia \ gr., at 9; cal. 3 grs., c[uin. 5 grs., at 1 and 5. 20;'A. Worse; black 
vomit came on about the middle of the day. Died on the 23d. 

This case was considered in a fair way of recovery on the 16th, 17th, and 
morning of the 18th; and, though there was no actual proof, it was strongly 
suspected and believed that food and liquor had been smuggled to him. Be 
this as it may, however, I have always regretted that the calomel had not been 
combined with every dose of quinia, uninterruptedly, from the very beginning 
on the 11th of October, until ptyalisni was produced. There was the more 
reason for this course, as he was a notorious drunkard, and had been on a 
. drunken frolic since the 1st of October, on his arrival from Castle Pinckney. 

Cases 63 and 64. — Private Charles Thappler, K, sober and well-behaved 
in all respects, was taken with yellow fever on the 14th October, and was 
treated principally by quinia, with a small quantity of calomel at the com- 
mencement. He had the usual symptoms at the beginning of the disease, and 
in the progress of the case his face became quite yellow. He went to quarters 
on the 1st November, and on the 7th, Sth^ and 9th said he was fit for duty. 



1854.] Porter^ Climate^ etc., of Fort Moultrie and SuUivan^s Idand. 61 



and on the last day he was marked ^^duty to-morrow." On the morning of 
the 10th he was brought to the hospital, and appeared to be very sick; intense 
pain of the frontal and orbitar regions; eyes tender, suffused, and the con- 
junctival vessels were injected; face of a dusky red. Cal, 5 grs., quin. 10 
grs., at 9; \ oz. ol. ricin. at 11; 10 grs. quin. at 1 and 5. Night. Cal. 1 gr., 
quin. 10 grs., opii ^ gr., at 9, 1, and 5. Wtli. Quite yellow. Cal. 1 gr., quin. 
10 grs., opii I gr., at 9, 1, and 5. ^l'2fh. Mouth sore. The patient was now 
put on small doses of quinia, brandy, mist, ammon. et camph., for a time, beef- 
tea, &c. Duty December 17. 

It may be thought singular by those who contend that yellow fever attacks 
a person but once in a lifetime, and by those vfho consider an attack of the 
disease as a preservative against future attacks, provided the person does not 
spend a winter at the North, to find that this patient is registered as having 
had the fever twice in about one month. Many will consider the second 
attack as a relapse, but this is not my opinion, for the patient was well. A 
more singular instance than this occurred at Pascagoula in 1848. One of the 
hospital matrons, who occasionally drank too much, had severe yellow fever, 
■and in its progress every symptom occurred which may be expected in this dis- 
ease, except black vomit, induing yellow skin, hemorrhage from the mouth 
and fauces, and uterine hemorrhage. She recovered, went on duty, and did 
her usual work for more than two weeks, went out of camp in all directions, 
got intoxicated, and at the end of all this she was again tnken with yellow 
fever, had black vomit, and died. I did not think her last attack a whit more 
severe than the first, until bla.ck vomit made its appearance. 

Case 65. — Private Thomas Johnson, M, drunkard, was brought from the 
guard-house, in which he had been confined by sentence of court-martial, 
with yellow fever, at lOj o'clock A. M., October 19. This man was a cor- 
poral when his company arrived at the post on the Ist of October, but he had 
been beastly drunk, and had been tried, broken, and confined. On going 
into hospital he had every symptom of ma-lignant yellow fever; skin of a 
dusky yellow (he had swarthy complexion) ; and in addition, the nervous 
system seemed to be in a state bordering on delirium tremens. Cal., quin. 
aa 10 grs., morph. I gr., ol. ricin. at 1 o'clock; at 3, quin. 10 grs. Night. 
<^uin. 5 grs. ; cal. 1 gr. at 6, 9, 1, and 5. I^th. Quin. 5 grs. at 9, 12, 3, and 
6. Night. 10 grs. quin. at 9, and 1, reveille (about 6 A. M.). Cal. 5 grs., 
morph. \ gr. at 9. 21st. Cups and large blister to epigastrium ; quin. 5 grs., 
cal. 1 gr., at 9, 12, 3, and 6. Night. Quin. 10 grs., cal. 2 grs., at 9, 1, and 
5, and brandy and water. 22c?. Quin. 10 grs. at 9, 1, and 5, and brandy; 
same at night, and 5 grs. cal. at 9. 23c?. Quin. 5 grs., every third hour ; 
5 grs. cal. at 9 P. M. 24^^. Quin. 5 grs., cal 1 gr., every third hour, day 
and night, and brandy. The calomel and quinia were continued until the 
28th, when black vomit came on, and he died on the 29th. Perhaps there 
was an oversight in this case, in not giving the mercurial with every dose of 
the quinia, both day and night, from the very commencement. This was de- 
termined upon in every case which might occur hereafter. But this case was 
a bad one from the beginning, and it may be said that there was so much the 
more reason to push the remedies, to which opinion I agree. 

Case 66. — Private John Sheridan, M, sober, was taken with yellow fever 
on the 19th of October, and reported to me at 6 P. M. Cal; quin., aa 10 
^0, LV.— July 1854. 5 



62 Porter, Climatey etc., of Fort Moultrie and Sullivarts Island. [July 



grs. ] quia. 5 grs., cal. 1 gr., at 9, 1, and 5, at night. 20?A. Quin. 10 grs., 
at 9 J 1, and 6. Night. Quin. 5 grs., at 9, 1,-and 6 ; and cal. 5 grs., opium 
J gr., at 9. 21s^. 01. ricin., 5 grs. quin., every three hours. Night. Quin. 
10 grs., cal. 5 grs., morph I gr., at 9 ; quin. 5 grs., at 1, and 10 grs. at 5. 
22<i. Quin. 10 grs., at 9, 1, and 5, and 5 grs. at same hours of the night, 
with 1 gr. calomel. 23fZ. Quin. 5 grs. every third hour; and at night 5 grs. 
every fourth hour, with 5 grs. cal. at 9. Brandy at same time. 24^A. Quin. 
5 grs. fourth hour. Night. Quia. 5 grs., cal. 1 gr., third hour; brandy. 
25^A. Quinia continued day and night, with 1 gr. cal. every dose at night ; 
wine. 26/A. Quin. 5 grs., cal. 1 gr., every three hours, and wine. At night, 
quin. 3 grs., cal. 2 grs., opii ^ gr., at 9, 12, 3, and 6, and brandy or wine. 
'Ilth. On visiting the hospital this morning I was gratified to find the patient 
complaining of a very sore mouth, and on the 28th there was severe ptyalism. 
It must be confessed that, until the morning of the 27th, the patient's life 
was despaired of, and that I began sincerely to regret not having given calo- 
mel with every dose of quinia from the first. This man made one among 
eight sick whom I set down as fatal cases on a certain night visit, but fortu- 
nately only two of them died, Johnson and Schmidt. So ill were some of 
the sick in the last part of October. From the time that ptyalism faily set 
in, Sheridan was treated with small doses of cjuinia, brandy, chicken-broth, 
beef-tea, &c. Duty, November 27th. 

Case 67. — Private Thomas Boyd, K, a great drunkard, was brought from 
the guard-house, where he had been confined for bad conduct since the 19tk 
day of August, by sentence of general court-martial, to hospital on the 26th 
of October, about 10 o'clock A. M., with severe yellow fever. He had in- 
tense pain of the frontal and orbitar regions ; the eyes were tender, suffused, 
and the vessels were highly injected; the face was of a dusky brown (he has 
dark complexion), and altogether, the case was so unpromising, that I con- 
sidered the result as settled. Mustard bath, and sinapisms; cal., quin., aa 10 
grs., and repeat at 2 P. M. ; quin. 10 grs., cal. 1 gr., at 6. Night. Medicine 
had operated; quin. 10 grs., cal. 2 grs., opii + gr., at 9, 1, and 5. 21th. Cal. 
5 grs., quin. 10 grs., at 9, 12, and 3 ; sinapisms, cups, and a large blister to 
epigastrium. Night. Quin. 5 grs., cal. 2 grs., opium ^ gr., at 6, 9, 12, 3, 6, 
to-morrow morning. 28/'7i. Very sick ; skin of an intensely dark -yellow. S 
A. M., cal. 10 grs., opium J gr. ; quin. 10 grs., cal. 2 grs., opium | gr., at 
* 10, 2, and 4. The medicine at 8 and 10 o'clock was doubtless retained ; but 
the two other doses were probably rejected, for the patient vom-ited several 
times in the course of the afternoon. Before 4 o'clock P. M., while I was 
standing by him, he threw up a quantity of fluid which appeared to be, in every 
respect, commencing black vomit, and the result of the case was considered as 
settled. He threw up two or three times after this, the contents of the sto- 
mach each time being of a darker hue, and more nearly resembling real black 
vomit, and I had no reason in the world to doubt that the real vomito prieto 
had begun. He was directed to have nothing but light drinks, as small 
quantities of iced mucilage, and towards sunset the stomach became more 
. quiet. 9 P. M. Has not vomited since sundown. Although the case was 
regarded as necessarily fatal, it was determined to try one dose more of medi- 
cine; and 10 grs. cal., and I gr. opium were administered. Directions were 
given for him to take nothing for three hours after, and then to take a little 
wine and water, brandy and water, or such other drink as he might prefer ; 
and I remarked to the steward: ''If he does keep the medicine down, it will 
be of no more use than so much savrdust." 2^th. On going to the hospital 
this morning,*my first inquiry was about Boyd. The steward said he was 



1854.] Porter, Climate, etc, of Fort Moultrie and Sullivan's Island. 63 

better, and I replied that I did not believe it, for it was scarcely possible; the 
steward said that he must certainly be better, for his stomach had been quiet 
all night, and he had a very sore mouth, to which I replied, "I don't believe 
it, but let's go and see;" and we found him with a sore mouth indeed, no un- 
certain one, but a severe ptyalism had begun ; face swollen, tongue enlarged, 
teeth and gums very sore, and a decided mercurial fetor of the breath. From 
this date, small doses of quinia, , brandy, chicken-broth, beef-tea, gargles, 
enemata, &c., were used; but it was several days before we could be per- 
suaded that the patient would be saved, as I had never seen one recover with 
even commencing black vomit. Duty, November 27th. This case was saved, 
in my opinion, by the energetic administration of calomel and quinia from the 
first. 

Only two more cases will be given from the fort, although others might be 
prepared, and these two cases will show the decided treatment pursued near 
, the close of the epidemic. 

Case 68. — Antonio Knoche, ordnance soldier, temperate, was taken with 
yellow fever on the 31st of October. He was sent from the Charleston Arse- 
nal to be tried by court-martial, on the 6th day of September, and had been 
confined since that time by sentence of the court. Very yellow. Quin., cal.^ 
aa 10 grs., at 9 and 1 ; quin. IJ) grs., at 5. Niglii. Quin. 10 grs., cal. 2 grs., 
opium ^ gr., at 9, 12, and 3; and 5 grs. quin. at reveille. Novemh&r 1. 
Quin. 10 grs., cal. 2 grs., opii \ gr., at 9, 1, and 5. Might. Cal. 1 gr., quin. 
6 grs., opium | gr., at 9, 12, 3, 6. 2d. Quin. 5 grs., cal. 1 gr., opium ^ gr., 
at 9, 12, 3, and 6; same at night. 3(i. Quin. 10 grs., cal. 1 gr., at 9, 1, 
and 5, and J gr. opii at 9 and 5 ; same at night, and ^ gr. opium each dose. 
Brandy. 4:th. Quin. 5 grs,, cal. 1 gr., every four hours, day and night, and 
^ gr. opium with each dose at night; brandy, bth. Same. Ntglit. Cal. 1 
gr., quin. 10 grs., opium ^ gr., at 9, 1, and 5, and brandy; and in addition, 
cal. 5 grs., opium J gr., at 9. Qth. Mouth sore. From this date took quin., 
brandy, opium, beef-tea, chicken-broth, &c. Although it was difficult to get 
the system under mercurial influence, and a large quantity of calomel had to 
be given, convalescence was rapid, and he went to duty on the 16th of Nov. 

Case 69. — Sergeant James F. Cross, M, sober, was taken with yellow fever 
on the 4th of November, and reported to me at 11 5 o'clock A. M. The pain 
of the frontal regions and orbits was very severe; eyes tender, suffused, and 
vessels injected; severe pains of the back and limbs; face of a dusky yellow, 
his complexion being swarthy. Cal. 5 grs., quin. 10 grs., and repeat at 3 
P. M. ; cal. 1 gr., quin. 5 grs., at 6 P. M. Night. Cal. 2 grs., quin. 10 grs., 
opium ^ gr., at 9, 1, and 5, and cal. 5 grs., opium ^ gr. at 9, in addition. 
bth. Very yellow. Quin. 10 grs., cal. 2 grs., opium ^ gr., at 9, 1, and 6. 
Night. Cal. 1 gr., quin. 10 grs., opium ^ gr., at 9, 1, and 5, and 5 grs. cal. 
and J gr. opium in addition at 9. Qth. Some appearance of ptyalism ; 5 grs. 
quin. every three hours; ^ oz. ol. ricin; at night, 5 grs. quin. every 4 hours; 
cal. 3 grs., opium, J gr., at 9 P. M. 1th. Ptyalism. Small doses of quinia, 
hereafter, brandy, chicken-broth, beef-tea, &c. Convalescence was rapid. 
Duty, Nov. 28th. 

We will now notice some interesting cases wholly unconnected with the 
garrison of Fort Moultrie. 

Case 70. — Mary McDonough, wife of Edward McDonough, about 25 years 
of age, one child, and is enceinte, residing in a large shell of an old house, open. 



64 Porter^ Climaie^ etc., of Fort Moultrie and Sullivan^ s Island. [July 



. to the wind and rain, said old house being known as the " Island House/' was 
ill on the 29th and 30th of September, and had undoubted yellow fever on 
the 1st of October. There were the usual intense pain of the frontal and 
orbitar regions, sufiused and injected eyes, &c. Calomel 10 grs., at the first 
visit, and no more was given during the disease, her situation being the reason; 
but quinia was freely given, say 10 grs. every four hours at first, and after- 
wards in 5 gr. doses. Oct. ?>d. Profuse epistaxis ; fortunately, no tendency 
to uterine hemorrhage; skin quite yellow. From the 3d, the date of the 
epistaxis and yellow skin, small doses of quinia were given, and brandy, 
chicken- broth, &c. She went to town two or three times a week;, but never 
stayed over night. Recovered. 

Case 71. — Margaret McDonnell, Irish, 18 or 20 years of age, living with 
the McDonoughs, was taken with yellow fever on the 7th of October. She 
had been in Charleston but twice for three months, and never stayed there at 
night. Was there last on the 2d of October. Catamenial discharge in the 
week previous, but completed, and no uterine hemorrhage during the fever. 
Epistaxis on the 9th, and subsequently considerable hemorrhage from the 
mouth and fauces. She was put on cal. and quin. ; on the third day the 
mouth was sore, and she recovered. 

Case 72. — Edward McDonough was taken sick with malignant yellow 
fever on the 26th of October. The symptoms were severe at the commence- 
ment ; the supra-orbitar pain was intense ; eyes tender, suffused, and the con- 
junctival vessels were highly injected ; skin of a dusky yellow, his complexion 
being swarthy. He was put on regular doses of cal. and quin. ; sinapisms ; 
cups; blisters, &c. 28^/i. Epistaxis, and very yellow. 29^A. Mouth very 
sore; small doses of quinia, brandy, mist, ammon. et camph., chicken-broth, 
beef-tea, &c. Recovered. 

A contagionist will say that Mary McDonough took the fever in town, and 
that it proceeded from her to the girl and Edward McDonough, who had not 
been in town for weeks. But if the disease was contagious, why did not the 
other members of the family suifer ? There were several boarders, no less 
than eight ; and only one, who went to town daily, and was drunk daily, 
had any kind of fever, the remaining seven escaping. More than this — 
several persons I know visited Edward McDonough, who had the most 
malignant fever of all, in all stages of the disease, and not one of them, to 
my certain knowledge, contracted any kind of fever ; they had no fever during 
the year. 

Case 73. — Wagner, a Frenchman, discharged soldier, residence in Middle 
Street, east of the fort, and near the hotel, was taken with remittent fever 
on the 2d of October. This was a light case, and I did not visit him more 
than three or four times. He was in Charleston about a month previous, 
worked all day there, but did not stay at night. Went fishing about a week 
before the attack, and again the day before, and both times he was exposed 
to the evening air in the "creek'' between Sullivan's and Long Island. 

Case 74. — Evaline, free mulatto woman, living with the above-named 
Wagner, was taken with severe yellow fever on the 19th of October. Intense 
pain of the frontal and orbitar regions; forehead hot and dry; eyes very 
tender, suffused, and vessels highly injected; severe pain of the back and 
limbs. On the 23d, profuse uterine hemorrhage came on, and the sclerotic 
coats were very yellow. The skin was also of a very dingy and singular 



1854.] Porterj Climate, etc., of Fort Ifoultrie and Sullivan's Island. 65 

appearance. For a few days she was very ill; recovered. She had been in 
bad health during the summer^ being enceinte, and had not been from Sulli- 
van's Island for more than three months; had seen no sick person since July 
except Wagner, and she had not been from her house since her child was 
born, on the 8th of September, until the day before she was attacked with 
this fever, when she called on a coloured girl from Santee, in a house near 
by, who was sick with country fever. To my certain knowledge, her health 
was so poor that she could not go from home for several weeks previous to 
delivery, on the 8th of September; and after her confinement she was so ill 
and infirm as to render it impossible for her to leave home until almost up 
to the very day of being herself seized with the fever. Again, there was 
no person sick with yellow fever with whom she could possibly come in con- 
tact between the 8th day of September and the 19th of October; or, iudeed, 
from the last of August to October 19, for she was unable to leave the yard; 
which settles the question in regard to contagion. It is my deliberate opinion 
that this case originated on Sullivan's Island. 

Case 75. — Miss A. F- , in the sixteenth year of her age, was taken with 

yellow fever in Charleston on the 18th day of October, and came to Sulli- 
van's Island on the 19th; but I was not called to see her until past 3 o'clock 
P. M., after she had been sick about thirty hours. She had been in Charles- 
ton about five weeks, from Canada East, her friends thinking it best for her 
to come south on account of a troublesome cough. Catamenia had never 
appeared. Having been ill so long the case presented a most unpromising 
appearance, and so the friends were informed. The patient took calomel, 
quinia, and ol. ricini on the first day, and afterwards some calomel with the 
quinia, and the latter was given as fast as was considered judicious; but the 
case progressed in the most malignant manner to the 21st, when there was 
great irritability of the stomach ; and it is uncertain how much medicine was 
retained afterwards. Sinapisms, cups, and a large blister to the epigastrium 
had been used. 22d. Every appearance of the first stage of black vomit, 
which continued to increase until I had no hesitation in pronouncing that 
the fatal precursor had taken place. To take such drinks during the night 
as are most agreeable, iced or without, and a little brandy in some shape, if 
possible. 23d. Early; it was reported to me that the patient had thrown 
up several times during the night, and that about 3 o'clock the vomit ap- 
peared in the most decided manner. Since that time the stomach had 
remained quiet. I could easily credit these reports, both from what I had 
seen the day and night before, and from the present appearance of the patient, 
for she appeared to be in extremis; pulse frequent and feeble; skin with the 
peculiar yellow fever sensation to the touch, and clammy; extremities cold; 
and the eyes, face, and neck intensely yellow. External applications; ices, 
and iced mucilages; brandy in small quantities in some shape; and mist, 
ammon. carb. every two hours. In truth, she was considered moribund. 
Hemorrhage from the nose and mouth came on in the early part of the day, 
continuing at intervals during the 24th and 25th; after the 25th there was 
but little hemorrhage. On the 24th, the stomach remaining quiet, and the 
mist, ammon.. appearing to agree better with that organ than anything else, 
the patient was directed to take a drachm of ib every hour, day and night, 
unless asleep; and as there was troublesome cough and restlessness, I gr. 
morphia was given every night from this date. Brandy, in some form, was 
recommended, if she could be prevailed on to take it; and a little chicken 
tea was ventured upon. Mist, camph. was afterwards combined with the 
ammonia mixture. The young lady finally recovered, most unexpectedly to 



66 Porter, Climate^ etc., of Fort Moultrie and SidUvan's Island. [Julj 

myself, and the severit}^ of the fever may be inferred frora the fact that she 
lost her hair subsequently. 

This case and Boyd (Case 67) are the only ones I have ever known to re- 
cover after black vomit had come on, ever so slightly, in all my experience; 
The Charleston physicians report a number of recoveries after the occurrence 
of this usually fatal symptom; more, I believe, than in former epidemics. 
We have all read of these recoveries, and no one had reason to doubt the fact 
of their sometimes occurring, but I never expected to see an instance. These 
two patients were very different; Boyd was a very great drunkard, and, the 
original organization was worn out and could not be trusted ; this young girl 
had led an innocent life, and though there was tendency to pulmonary dis- 
ease, much might be trusted to nature. In both of these cases, however, 
there was only incipient black vomit, the inner coat of the stomach remain- 
ing intact, for we can scarcely conceive of recovery taking place after con- 
firmed black vomit, when the mucous coat is in a state of disorganization. 

During the fever of this young lady, there were four white females who 
were pre-eminently exposed, being in the room and about the patient in all 
stages of the disease, and not one of them contracted it. I am not certain 
whether one of them, an elderly lady, had suffered an attack of this fever or 
not, but I am positively certain that the other three never had the disease, 
and two of them had been in the low country of the South not more than 
a year or two. And let me remark in this place, that in all cases where 
persons are mentioned as not contracting yellow fever, though they had been 
exposed to it, it is intended to assert that none of these persons so exposed 
have ever had the disease. Besides these females, there were seven male 
boarders in the house who did not enter the patient's room, not one of whom 
had yellow fever, and only one was at all ill. This man had slight remittent 
at the time the young lady came from town, and I recommended infusion of 
Serpentaria Yirginiana, and nothing more was necessary. I saw the man 
but once, so light was his fever. These were the only cases of fever in the 
house during the year; and how could all these persons, especiall}^ those 
three females in attendance, escape the contagion of so malignant a case'/ 

Case 76. — T. C , brother of J. C (see Case 47), came from 

Charleston sick with yellow fever on the 14th of October. Complexion dark, 
now of a dusky appearance, and on the 15th the skin was of a dark yellow, 
and the sclerotic coat of the eye was yellow also. The treatment of this case 
consisted mainly in giving moderate doses of quinia at first, with which a 
grain or two of calomel was often combined, the tongue being loaded; after- 
wards mist amnion., brandy, chicken tea, &c.; and in due time he recovered, 
though greatly reduced. 

In this house of J. C. (see Case 47) there were two cases of yellow fever 
during the epidemic; and in the family there were two young ladies and an 
Irish servant girl, who were exposed in Mrs. C's case, and Mr. C. was exposed 
in both cases; there were six male boarders, all of whom were exposed in the 



1854.] Porter^ Climate^ etc., of Fort Moultrie and Sullivan^ s Island. 67 

case of T. C; and there were also three children in the family — making 7 
men, 3 women, and 3 children, or a total of 13 persons in all. Not one of 
them had fever during the season. Not one of the 10 persons, seven men 
and three women, ought to have escaped, if yellow fever is contagious. 

Case 77. — Mrs. Harris, wife of Kev. Matt. Harris, Post Chaplain, was 
taken with yellow fever in the night of the 8d of November, and early the 
next morning I saw her. She had the usual symptoms; intense paio of the 
supra-orbitar regions, suffused eyes, ka. On the Sth, there was epistaxis. 
Recovered. The residence of Mr. Harris was within one-quarter of a mile of 
the steamboat landing, the first door west of the Episcopal church, and about 
midway between Middle Street and the back beach. This lady had not been 
to Charleston since July, nor had she seen a fever patient during the whole 
summer. 

Case 78. — Mary Wagner, widow, residing in the family of Mr. Harris 
during the season, was taken with remittent in the livery of yellow fever, on 
•the 10th of November. She had severe supra-orbitar pain; eyes tender, suf- 
fused, and changed in appearance; dusky appearance of the face, though a 
blonde; severe pain of the back and limbs. Was taken with a severe ch^ll. 
She had not been from SulUvan's Island for six weeks, nor had she seen any 
fever patient. 

Case 79. — Mr. Harris was- taken with simple remittent fever, without a 
single sign of yellow fever, on the 16th of November. This was a case of 
undisguised remittent fever, of the simplest form. It was ushered in with a 
chill, and there was an evident tendency to a cold, hot, and sweating stage, 
every afternoon during its progress. The only untoward occurrence was an 
accidental ptyalism; 10 grs, cal. was given on the first visit, followed in a 
short time by ol. riciui, which acted admirably; and, three or four days 
afterwards, 5 grs. mas. hydrarg. was given in combination with other ecco- 
protics, which acted sufficiently in a brief period. These were the only mer- 
curials exhibited. The patient had not been in Charleston for three weeks, 
but he had seen yellow fever, of the most malignant character, repeatedly, 
during the epidemic. 

If Mrs. Harris had seen a single case of fever, it might be said that she 
contracted yellow fever by exposure to contagion. But she saw no person 
with fever during the epidemic; and the same may be said of Mary Wagner, 
who saw no sick person except Mrs. Harris. Mr. Harris, however, did see 
yellow fever, of the most malignant character, repeatedly, during the epidemic, 
as I have reason to know; and if his had been the first case in the family, no 
matter how mild and how simple the remittent, it would be said that he in- 
troduced the contagion from abroad. The natural order of events, according 
to the doctrine of contagion, was inverted, for those who might bid defiance 
to the disease had it worst, and the one who was repeatedly exposed had only 
a mild remittent, at the close of the season, the case of Mr. Harris being the 
last fever which occurred in my practice in 1852. Mrs. Harris's case indubi- 
tably originated on Sullivan's Island, for we can account for it in no other 
way. If yellow fever is contagious, three white persons (two nieces and an 
Irish girl, none of them children) ought to have taken it, for they were all 
exposed. 



68 Porter, Climate, etc., of Fort MouJtrie and SidlivariS Inland. [July 



Case 80. — Mrs. 0., residing on the back beach, northeast of the fort, was 
taken with remittent fever on the 15th of November. In a few days this 
changed into an obstinate quotidian intermittent, over which quinia appeared 
to have no control, and which yielded to Fowler's arsenical solution. On the 
7th of January, 1853, she was taken with tertian intermittent, which lasted 
until the 23d. On the 14th of February she was attacked with a tertian, 
which lasted until the month of July succeeding, without interruption, when 
it gradually broke up. Many remedies were tried without effect, and the dis- 
ease seemed to yield only to change of season. This patient ought to have 
gone North, or to Aiken, or to Buncombe, for change is essential in chronic, 
intermittent. She had not remained in Charleston over night since the 4th 
of July, 1852, and had not been there during the day for more than three 
weeks previous to the 15th of November, llesided on Sullivan's Island during 
the whole summer. 

We have done with the cases, and if they appear too numerous, it must be 
recollected that they were introduced in order to show the nature of the treat- 
ment, to show the origin of the fever, and to show that it was not contagious 
in the slightest degree. 

Treatment of Yellow Fever. — The general plan may be seen from the cases; 
adjuvants being almost wholly omitted from the reported treatment. Calomei 
and quinia were given in all cases from the beginning, and the former was 
never omitted from each dose in the last part- of October, when the disease 
assumed a more malignant character than before; and it may be remarked in 
this place, that if a mistake was made in treatment during the whole epidemic, 
it was in the cases of Fitzpatrick and Johnson (Cases 62 and 67), in which 
calomei ought to have been pushed with every dose of quinia to downright 
ptyalism. It is my opinion that each of these men might possibly have been 
saved, though notoriously great drunkards, and bad subjects, by this course of 
treatment, for no other method could have done it; but perhaps I have more 
reason to rejoice that the mortality was no greater. Fitzpatrick was strongly 
suspected, also, of having 'Splayed old soldier." Compare these two cases 
with some others, particularly cases 68 and 71. Bilious fever was treated 
on the same principles; the lighter the case^ the more care was taken to 
avoid ptyalism. 

It affords me great pleasure to bear testimony in favour of this plan of 
treatment during the epidemic, which was the same as that pursued by myself 
at Vera Cruz, in the summer of 1847; and this is the more cheerfully done, 
because it is not at present the fashionable treatment, like oil and lemon juice, 
snakeroot and salts, verbena, &c. &c. From the thousand infallible specifics 
advertised in the medical journals and newspapers for the cure of yellow fever, 
it may be inferred that every plan of treatment is somewhat uncertain, and 
that we have to contend with a malignant disease. The more certain cures we 
see advertised for any disease, the more uncertain is the treatment; and we 
see, notwithstanding infallible treatment, that yellow fever patients do die, as 
at New Orleans, Havana, Bermuda, &c. It may be said that my patients 
escaped in spite of the doctor, and this could be said if I had lost 15 or 20 of 



1854.] Porter, Climate, etc., of Fort 3Ioultrie and Sullivan's Island. 69 

them, in 48 cases of severe and malignant yellow fever, instead of 4 in 48; 
and, in reality, tlie physician ought not to he held responsible for more than 
2 cases out of the 4 fatal ones (see Cases 58 and 59). There was, however, 
a mortality of 4 in more than 100 cases of fever at Fort Moultrie. If mer- 
curials are so injurious in yellow fever as is contended by many, whether by 
dissolving the blood, by creating great nervous irritation, by exciting inflam- 
mation of the mucous coat of the stomach and duodenum, or for any other 
reason, most of my patients ought to have died; but did they die ? We will 
see when we come to the statistics of the epidemic. 

Venesection was not practised in a single instance; cups were freely em- 
ployed, but leeches were not used in any case, cups answering every purpose. 
Anodynes were in universal use, particularly at night. Ice was freely used 
in a few special cases, but it was not generally required. Sinapisms and epis- 
pastics were freely applied. Brandy, in. some shape agreeable to the patient, 
was universally used, more so, perhaps, than in any epidemic I have wit- 
nessed; and, pretty early in the disease, with the best effect, in the cases of 
temperate females as well as with old topers. Mist, ammon. carb. was em- 
ployed in the advanced stages of some of the most malignant cases, with 
excellent effect. Ale and wrhe were sometimes given when the brandy did 
not agree with the stomach. So soon as the first stage of the disease had 
somewhat passed, chicken and beef-tea were given in small quantities. It is 
not necessary to go more into detail. 

Symptoms have not been detailed. It is easy to perceive, from almost 
every case, what are considered diagnostic symptoms, and the rest have been 
almost wholly omitted. Pain of the back and limbs has not been much 
noticed, for it is by no means pathognomonic, occurring in every southern 
fever. It is mentioned in this place for the purpose of alluding to the dis- 
position, generally prevalent at the commencement of the yellow fever, to call 
all fevers dengue, after its predecessor of 1850, when these pains were so 
common; but they were just as common and severe in this fever. They are 
common in all southern fevers. The pulse was slow, frequent, full, weak, 
(fcc, in all stages'^of the different cases. The tongue is no criterion. It was 
nearly natural in appearance, flabby, white, yellow and loaded, brown and 
moist, brown and dry, black, had red edges, &c., in different cases. The 
organ presented almost every variety of appearance. 

Little will be said concerning the nature of yellow fever. When the dis- 
ease first occurred to me it was regarded as sui generis — as different from all 
other southern fevers, but it must be confessed that this opinion has been 
considerably modified ; and at the present time it is believed that intermittent, 
remittent, continued, congestive, and yellow fevers are nearly related, if not 
modifications of the same fever, all being southern bilious fevers, the nervous 
system in some and the blood in others being pre-eminently affected. Whether 
the difference in these varieties of southern fever, in different seasons and in 
the same season, depends on a simple difference of intensity in the predis- 
posing and exciting causes with one and the same materies moi-li ; whether 



70 Porter, Climate, etc., of Fort Moultrie and Sullivan's Island. [July 

different causes exist at the same time, developing the different forms of fever; 
or whether there is a blending and conversion of types, as is maintained by 
Dr. Dickson — all remains to be determined. It is easy to diagnosticate a 
mild, open, remittent fever from a malignant yellow fever; but the different 
rounds between the extremities of the ladder are so numerous as to render 
the central one, the dividing line, difficult to distinguish. This was particu- 
larly so in the fevers of 1852, and some cases were registered as remittent 
fever, in the month of September, which might have been, with equal pro- 
priety, named and reported yellow fever. As the fevers became more ma- 
lignant in the month of October, there was no sort of difficulty in determining 
their true character. 

STATISTICS OF THE EPIDEMIC. 



I. Table showing the Class of Persons attached to the Garrison of Fort 
Moultrie, with their Febrile Diseases and Mortality. 









u 


O 


NO. SICK PER 


DEATHS 


MORT.ALITT PER 











o 




1000 WITH 


FROM 


CENT. FROM 






DESIGNATION. 


strength. 


j No. cases c 
1 low feve 


o 

it 


.Total num 
all fever 


1 Yellow 
1 fever. 


I other 
1 fevers. 


All 
1 fevers. 


o' U 


All other 
fevers. 


Yellow 
fever. 


AH 

fevers. 


Deaths pei 




9 




4 


4 




444 


444 














112 


33 


27 


60 


295 


241 


535 


"4 




12.12 


6.66 


35 


White male adults, not military 


9 




3 


3 




333 


333 












White adult females . . . 


29 


"s 


15 


23 


276 


517 


793 














25 




11 


11 




440 


440 












Coloured male adults . 


2 
























Coloured adult females . . 


7 




2 


2 




285 


285 












Coloured children .... 


7 




2 


2 




285 


285 














200 


41, 


64 


105 


205 


320 


525 


4 




9.75 


3.80 


20 



II. Table showing the Exposure, Fevers, &c., of different Classes of Persons 
during the Epidemic. 









u 


mhcr 
ever. 










DESK3NATI0N. 












Guard 


Fatigue, duty, or 


Provision for 




fl 


t- 


U 


C 




duty. 


previous exposure. 


respiration. 







1 Cast 
1 low 


1 0th( 


3 

Si 


P 










9 




4 


4 




Light 


Light 


Very good. 


Enlisted men . . . 


112 


33 


27 


60 




Severe 


Severe 


Good. 


OiScers' ladies . . 


7 


1 


4 


5 






None 


Very good. 


Soldiers' wives . . 


18 


7 


9 


16 


> 
0) 




Severe 


Good. 


White female servants 


4 




2 


2 


ci 




Light 


Good, 


White males, not sol- 




















9 




3 


3 






Moderate or light 


Good. 


White children . . 


25 




11 


11 







None 


Good. 


Coloured males 


2 












Light 


Moderately good. 


Coloured females 


7 






"2 






Moderate 


Moderately good. 


Coloured children 


7 




2 


2 






None 


Moderately good. 


Total 


200 


41 


64 


105 











1854.] Porter^ Climate^ etc., of Fort Moultrie and Sullivan^ Island. 71 



III. Tahle showing tJie Hahit of Intemperance in different Classes of Persons 
helonging to the Garrison, luith their Febrile Diseases, dr. &c. 















SOBER. 


DRINKERS. 


HARD 


DRUNK- 


DEATHS. 
















PERS 


ONS. 




DRINEERS. 


AR 








o 
o 










s 
























o 


DESIGNATION. 
































c3 










i 




ll 


> 








erfev 


O U 


o 


O u 


"5 


ft 




p 




.£ 


% 


P 


1 1 
















% > 










m 


(= 




P 




o 




o 




o 


>i if; 


O 




Pi 




Enlisted men of Com- 


































pany E . . . . 


21 


12 


9 


s 


4 


1 


4 




2 




1 


1 










Do. Company K 




on 


D 


9 


1 '7 


5 


6 




o 


o 


1 


5 


5 








Do. Company M 


43 


18 




8 


14 


7 












9 


1 


4 


4 


93 


Do. other corps 


8 


1 




1 


1 


1 










"l 












Soldiers' wires . . 


-I o 

lo 


1 o 

lo 








7 


9 




















White female servants 


4 


4 








2 




















White males, not sol- 




































9 


5 


1 


2 


1 




o 












1 








White children . . 


25 


25 










11 




















Coloured males . . 


2 








2 
























Coloured females 


7 


7 










o 




















Coloured children 


7 


7 










2 




















Total 


184 


117 




16 


39 


21 


38 




4 


4 


3 


15 


11 


4 


4 


22 





































lY. Ta5/e Comparison between Companies K and M, from the 1st of 
October to the end of the Epidemic. 





















02 
















SOBER 


DRINKERS & 


o 
?> 


3 
















JIEN. 


DRUNKARDS. 


.3 


























5: 






o 
o 






S 

u 

o 


inkards ar 
rinkers. 




13 

o t> 


es of 
er fevers. 


1 


er fevers. 


_o 

O r^ 

X u 


u 

^ .. 
o8 

tt- o 
O r-- 

? ^ 




o 

s. 


REMARKS. 








c 


s > 










1 ^ 










m 


H 








O 




o 








Enlisted men of 
























In every table, and 


Company K 


20 


25 


45 


5 




6 


1 


244 


22 






in all cases, it is to be 
recollected that Com- 


Enlisted men of 
























Company M 


18 


25 


43 


7 




11 


1 


419 


23 


4 


93 


pany M was not pre- 
sent in September. 



Y. Table of different Classes of Persons, not Military, pertaining to the 
Garrison, with their Febrile Diseases. 





Numljei 


Xo. cases 


No. sick 


No. cases 


No. sick 


No. cases 


No. sick 






of 


of 


per 1000 


remit- 


per 1000 


in all. 


per 1000 






persons. 


yellow 


witli 


tent 


with re- 


Total 


witti all 






fever. 


yellow 


fever. 


mittent 


fevers. 


fevers. 










fever. 




fever. 








Of&cers' ladies . . . 


7 


1 


143 


4 


571 


5 


714 




Soldiers' wives . . . 


18 


7 


389 


9 


500 


16 


889 




White female servants . 


4 






2 


500 


2 


600 




White males .... 


9 






3 


333 


3 


333 


6 
c 


White children . . . 


25 






11 


440 


11 


440 





Coloured adult males . 


2 














Coloui-ed adult females 


7 






2 


286 


"2 


286 




Coloured children . . 


7 






2 


286 


2 


286 




Total 


79 


8 


101 


33 


418 


41 


519 





\ 



72 Porter^ Climate^ etc., of Fort Moultrie and Sullivan's Island. [July 



VI. Table of Mortality/ in Yelloio Fever in all the Cases Treated. 





Number of cases. 


Deaths. 


Mortality per cent. 




33 


4 


12.12 


Women of garrison .... 


8 






Not of garrison — citizens . . 


7 








48 


4 


8.33 . 



The first table requires no explanation. The second, third, and fifth tables 
give the different classes of persons attached to garrison more distinctly than 
the first, the previous exposure, provision for respiration, and their character 
for sobriety, with their febrile diseases and mortality. Under the head of 
officers' ladies are included visitors, who remained through the epidemic in 
precisely the same condition as the class in which they are included. Among 
soldiers' wives are included several women who assisted as laundresses, who 
married soldiers then, or shortly after, and whose situation in every respect, 
duty, fatigue, sobriety, &c., was the same as the class into which they are 
incorporated. This class of persons was temperate. They were exposed to 
great fatigue during the heavy rains, and the cases of fever were no less than 
889 per 1,000, but there was not a single death. The mortality among en- 
listed men was 35 per 1,000 ; and in Company M, the only company which 
lost men, the mortality was 93 per 1,000. The provision for respiration was 
good for both classes, the fatigue and exposure were great in both classes, the 
drunkenness was great among the men, and there was none of it among the 
women; and although the sickness per 1,000 among the enlisted men was 
535, and among the camp-women 889, the mortality was nothing in one 
class, and in the other 35 per 1,000, or 6.66 per cent, of all fevers. The 
fevers of this year, both remittent and yellow, were universally more easy to 
manage among females than in men. The third table shows the fevers among 
drunkards, with whom is classed one habitual opium-taker. From this table 
it appears that Company E had rather more cases of all sorts of fever than 
Company K, or 619 per 1,000, while K had 578 per 1,000 ; but the number 
of yellow fever cases was much less in E, amounting to only 95 per 1,000, 
while the number sick with yellow fever in K was 267 per 1,000 ; and in 
Company M, the yellow fever cases were 419 per 1,000. The number of 
soldiers' wives sick per 1,000 with yellow fever was 389; other fevers, 500; 
all fevers, 889, as seen in the fifth table, but there was not a single death. 
To what can this difference be ascribed? To what is the exemption of Com- 
pany E from yellow fever, as compared with Company K, to be attributed, 
unless to the comparative freedom from hard drinkers and old drunkards? 
The two companies had been side by side during the whole year, and their 
barrack-rooms, duties, and exposures, had been alike in every respect. The 
following table exhibits the prevalence of fever among sober men and drunk- 
ards in the respective companies :— 



1854.] Porter, Climate^ etc., of Fort Moultrie and Sullivan's Island. 73 



Company. 


Strength. 


SOBER MEN. 


HARD DRINKERS AND DRUNKARDS. 


Number. 


Yellow fever. 


j other fevers. 


All fevers. 


Sick per 1000 with 


Deaths. 


Number. 


j Yellow fever. 


j other fevers. 


All fevers. 


Sick per 1000 with 


Deaths. 


;=! ^ 

CP > 


li 


All 

fevers. 


. 


other 
fevers. 


All 

fevers. 


E 




21 


12 


1 


4 


6 


83 


33^3 


416 




7 


1 


5 


6 


143 


714 


857 




K 




45 


20 


5 


6 


11 


250 


800 


550 




19 


7 


6 


13 


368 


316 


684 




M 




43 


18 


7 




7 


388 




388 




22 


11 


1 


12 


500 


45 


546 


"4 



Company M was not present in September, and there was little fever other 
than yellow, in the month of October. The September cases are included in 
Companies E and K, and are almost entirely remittent — all but one. 

There were three men of other corps present during the whole epidemic, in 
whom yellow fever is apparently in an inverse ratio to the above statement; 
but this is not in reality the fact, for a sober man who had yellow fever was 
undergoing punishment (hard labour, confinement, &c.) by sentence of general 
court-martial ] the hard drinker, who had mild remittent fever, was on light 
duty, and was but little exposed ; and the one who escaped all fever, a thief, 
a liar, and a drunkard, also undergoing punishment for desertion by sentence 
of general court-martial, was an exception to all rules, being completely 
hardened, both morally and physically. 

TVe have high authority for asserting that intemperance is a strong predis- 
posing cause of fever in hot climates. Dr. Carpenter : — 

" Its efficacy has been generally attributed to the general disorder of the nu- 
trient process, and to the weakening of the vital powers, which it tends to 
induce ; but to us it appears that it possesses a more direct and special action. 
One of the best-established among the consequences of the introduction of alco- 
hol into the blood, is its rapid oxidation, whereby it is itself eliminated from 
the circulating current ; but, in thus greedily appropriating to itself the oxygen 
which the respiratory process supplies, it pi^events the oxidation of other sub- 
stances, of which it is one of the special objects of that process to get rid ; thus 
tending to induce the same condition of the blood, as that which is consequent 
upon obstructed respiration. And the peculiar potency of this cause in hot 
climates, where the oxidating process, as measured by the production of car- 
bonic acid, does not take place at above half the rate at which it is carried on 
in a colder atmosphere, is a strong confirmation of this view. 

The sixth table gives the number and mortality of the yellow fever cases, 
and at the risk of repetition, is intended to show the result of the practice 
pursued. A comparison of the cases with this table shows that the main 
remedy, one in universal use, the combination of calomel and quinia, was not 
so inefficacious, nor so prejudicial, as has been represented by many physicians. 
If the combination had been inefficacious, there must have been a large mor- 
tality ; but it is scarcely probable that two such powerful articles of the Ma- 
teria Medica, which show their effects on the system so obviously, should 
prove inert, and their influence in this epidemic, either for good or evil, is 
undoubted. If prejudicial in their action, the mortality must have been 
frightful, for both articles were administered so freely that scarcely a chance 
was left for recovery. But there was no such mortality, and the treatment 



74 Porter, Climate, etc., of Fort 3Ioultrie and Sullivan's Island. [July 

was as successful as any mode of practice could be expected to prove in any 
circumstances. Much has been said against this mode of treating the disease, 
but what plan of treatment has ever proved infallible ? A clerical gentleman 
very kindly remarked to me one day, that he did not know of a more disgust- 
ing sight than to go into the wards of an hospital filled with sick undergoing - 
ptyalism ; I replied it was disagreeable, but to me it was not half so disagree- 
able a sight as to enter the wards of an hospital filled with patients having 
black-vomit. The occurrence of ptyalism in this yellow fever was never an 
unpleasant sight to me ; on the contrar}^, it was always hailed as the harbinger 
of recovery. If a simple mode of treating yellow fever can be devised, by 
which it may always be cured, cito, tute, jucunde, no one will more cheerfully 
follow it than myself, to the exclusion of calomel, quinia, cupping, blistering, 
and all other unpleasant remedies. 

Our limits will permit of but a single remark on the modus operandi of 
quinia. It is regarded by a very great majority of the profession as a seda- 
tive, but since the free use of it in the severe and malignant fevers of Florida, 
in 1839, ^40, and '41, I have regarded it as having a peculiar stimulant 
action on the nervous system; nor have I since seen reason to change the 
opinion. The salts of quinia seem to have a peculiar affinity, if we may so 
speak, for nervous matter, and hence their beneficial action in many diseases. 
Dr. Stevens believed that the sulphate has an efi"ect on the blood in malig- 
nant fevers, though not to the extent of some of the other alkaline salts. 

It may be said that this epidemic was of a mild character. It was not so 
malignant as that of St. Augustine, Florida, in 1841; nor was it so severe as 
the yellow fever at Pascagoula, Mississippi, in 1848, though more prevalent; 
but it appeared to be as grave a fever as that in Yera Cruz in 1847, though 
the mortality, from circumstances, was immensely greater in that town than 
on Sullivan's Island and at Fort Moultrie. A glance at the cases will show 
that the epidemic was not of a mild character. On a certain night visit in 
October, ten patients were considered in a very hazardous situation, but for- 
tunately only two of them were lost; the others recovered under the free use 
of calomel and quinia, which ought not to have been the case if the remedies 
were pernicious. The following table shows the number of all cases during 
the epidemic months, with the exception of three fever cases in August. 



MONTHS. 


DESIGNATION. 


strength. 


s 

> 

5 
c 


Yellow fever. 1 


3 

.5 

s 
5 


Cholera morbus 1 


Dysenteria acute. 


All other diseases. 


Total No. of case.s. 


Died. 1 


Cause of death. 


September 


Officers and enlisted men 


71 


24 


1 




1 


... 


3 


29 








Women, children, servants, &c. 


61 


15 


2 




2 


2 


4 


25 


"i 


Encephalitis, 


October 


Officers and enlisted rneii 


121 


g 


29 




1 


1 


4 


38 


3 


Yellow fever. 




Women, children, servants, &c. 


79 


12 


5 


2 




3 


2 


24 






November 


Officers and enlisted men 


107 


1 








2 


13 


19 


1 


Yellow fever. 




Women, children, servants, &c. 


74 


G 


1 


1 




2 


2 


12 








Total number of sick . 




61 


41 


3 


4 


10 


28 


147 


5 





1854.] DaltoDj Movements of the Glottis in Respiration. ' 75 



Every case of cliolera infantum, cholera morbus, and dysentery given in . 
the preceding table, occurred in persons Vno had not been from the island 
for weeks, and some of them had never been from the island in their lives. 
Every case originated on Sullivan's Island. Of the remittent fever almost 
every case originated here; for after the public notification of July 24, and 
the subsequent post regulation, not a man was permitted to stay in Charleston 
over night, and few wished to go there ; nor did the women and children 
who had these diseases go to town at all. It has been already shown that 
the yellow fever originated on Sullivan's Island, having proved in the pre- 
ceding pages that several cases of genuine disease — the very first cases too — 
had their origin here, among whom, in their order, are Sergeant McXair, 
Mary Ann Brassard, Margaret McXair, Deborah Doherty, Evaline, and Mrs. 
Harris, all of whose cases indubitably originated on this island, neither 
Charleston nor Castle Pinckney having had any agency in their production. 
About the origin of the disease there can be no question, for the cases of 
Sergeant McXair, Mary Ann Brassard, and Margaret McXair s-ettle it, with- 
out having recourse, as might be done legitimately, to an abundance of other 
fever cases (See Cases 1, 5, 6, 7, 9, 10, 13, 14, 15, 18, 19, c:c.) during the 
ej)idemic. 

The foregoing tables do not perfectly agree with the quarterly reports of 
sick in a few particulars, the mean strength not being the same as the full 
number of persons. (^To he continued 



Art. III. — On the Jlovements of the Glottis in Respiration. By John C. 
Daltox, Jr., M. D. X^ew York. (With two wood-cuts.) 

Eyert one must have observed, in examining the respiratory passages after 
death, how great a disproportion exists between the opening of the glottis and 
the caliber of the trachea below. The glottis itself presents the appearance 
of a narrow chink, while the passage for the inspired air widens ifi the lower 
part of the larynx, and in the trachea constitutes a spacious tube, nearly cylin- 
drical in shape, and over half an inch in diameter. In an adult male subject, 
in whom the respiratory passages were healthy, the space included between 
the vocal chords had an area of from 0.15 to 0.17 square inch; while the 
caliber of the trachea, in the middle of its length, was 0.45 sc^uare inch. It 
is evident, therefore, that for the purposes of respiration, either the glottis is 
too small or the trachea unnecessarily large ; at least, if we suppose the con- 
dition of the larynx after death and during life to remain the same. 

There are, in Longet's work on physiology, now in course of publication at 
Paris, in the article on the pneumogastric nerve, several allusions to a dilata- 
tion of the glottis during life, by which its capacity is increased in. inspiration 
whenever more air than usual is required. Longet, however, appears to 



76 DaltoD; Movements of tJie Glottis in Respiration. [July 

regard this dilatation of the glottis as uniform and permanent during ordi- 
nary respiration, while there is an alternate enlargement and diminution of 
its caliber only when the respiratory movements become forced or hurried. 
His words are (vol. ii. p. 314) : '^Lorsque la respiration est calme, on ne 
pent constater rien autre chose qu'un ecartement permanent de la glotte ou 
des narines; quand eile devient genee, ces orifices se dilatent d'abord outre 
mesure, puis reviennent bientot a leurs dimensions normales." The author 
speaks of examining the condition of the glottis, and the effect upon it of 
dividing the superior and inferior laryngeal nerves by simply " drawing the 
larynx forward/' I have myself never been able to obtain any satisfactory 
view of the glottis in living animals by this means. In the dog, even when 
the animal has been completely etherized, and the larynx drawn forward as 
much as possible by laying hold of the epiglottis with hooked forceps, I have 
not succeeded in getting anything more than a very indistinct view of the 
entrance to the larynx, and the vocal chords were always too deeply situated 
to be seen at all. I had recourse, therefore, during the past winter, to the 
following experiment, which I have repeated some half a dozen times since. 
The animal is to be etherized, and laid on its right side. The left common 
carotid is then to be tied, and the dissection continued so as to expose the 
oesophagus and the lower part of the pharynx. If an incision be now made 
into this canal, extending from just above the hyoid bone some two or three 
inches down the oesophagus, the larynx can be readily turned over from be- 
hind forward so as to bring into full view its posterior surface, the glottis, and 
the vocal chords. The observation can be continued for an indefinite time, 
by occasionally placing a sponge, moistened with ether, over the entrance to 
the larynx, and so keeping the animal in a condition of insensibility. These 
experiments have demonstrated that there is, during normal respiration, a 
constant and regular movement of the vocal chords, hy which the size of the 
glottis is alternately enlarged and diminished, synchronous with the inspiratory 
and expiratory movements of the chest. These motions are of the same cha- 
racter as the general automatic movements of respiration, of which they in 
fact form a part. It is at the same time, and by the same nervous influence, 
that the chest expands to inhale the air, while the glottis opens to admit it. 
When the chest collapses, the glottis returns to its original size, and the air 
is expelled through it from below. 

These motions, which may be called properly enough the " respiratory 
movements of the glottis," are increased in force when the respiration becomes 
.excited, the glottis opening more widely as the chest expands more fully. 
The variation in its size is also more strongly marked when the animal whines 
or cries. Then the glottis not only collapses during expiration, but is strongly 
contracted, and is actually narrower than in a state of rest, the chords being 
closely approximated so as to produce a vocal sound. But it is not necessary 
to the continuance of the movements that there should be any production of 
sound or any disturbance of the respiration. 

Notwithstanding the gravity of the operation necessary to expose the la- 



1854.] Dalton, Movements of (lie Glottis in Respiration. 77 



rynx, when the animal is thoroughly etherized the respiration is often per- 
fectly as quiet and regular as in the natural condition ; yet the movements of 
the glottis continue to be performed. At one time, I attempted to stop them 
hy pushing the etherization to excess ) and they, in fact, ceased after pro- 
longed application of the sponge, but only when all the respiratory movements 
were suspended together. When the motions of the chest and diaphragm 
began again, the movements of the glottis recommenced at the same time. 
Another fact, which I have twice verified, tends to show that this dilatation of 
the glottis is not, as Longet supposes, an extraordinary movement caused by 
the demand for an unusual supply of air to the lungs, but a part of the ordi- 
nary respiratory process. If a large opening be made in the trachea below 
the larynx, the movements of the glottis go on as before, notwithstanding an 
abundant supply of air is admitted by the artificial orifice. 

The separation of the Vocal chords during inspiration, and the consequent 
enlargement of the glottis, is produced by the action of the posterior crico- 
arytenoid muscles. By their contraction the arytenoid cartilages are rotated 
outward and downward, and at the same time drawn backward, so that the 
opening of the glottis is lengthened as well as widened. The movement may 
be readily produced after death on the fresh larynx of the calf by irritating 
the first terminal branch of the inferior laryngeal nerves. It will then be 
seen that the glottis opens, and at the same time the arytenoid cartilages are 
rotated outward. It can also be imitated on the human larynx by exposing 
the crico-arytenei postici, and drawing upon these muscles in the direction 
of their fibres. By this means the size of the glottis may be increased from 
0.15 to 0.27 square inch. As the vocal chords are composed mostly of elas- 
tic tissue, it is easy to understaud how they can be at the same time elongated 
and separated laterally. 



Fig. 1. 



Fig. 2. 




Human larynx, yiewod from above, Jn its ovdi- 
n&ry post-mortem condition. 0, opening of tlis 
glottis ; a, vocal chords ; b, thyroid cartilage ; c, 
arytenoid cartilages. 



The same, with the glottis opened, by separa- 
tion of the arytenoid cartilages. 



No. LY.— July 1854. 



6 



78 



Dalton, Movements of the Glottis in Respiration. [July 



As the respiratory movements of the glottis are produced by the action of 
the posterior crico-arytenoid muscles, they are, of course, entirely under the 
control of the recurrent or inferior laryngeal nerves ; and the section of these 
nerves instantly puts a stop to them, however vigorous they may have been 
previously. The glottis can then be neither expanded nor contracted, but 
remains collapsed, and even partially closes at every forcible inspiration. 
This tendency to occlusion of the glottis after section of the recurrents, which 
has been noticed by several experimenters, is a consequence of the paralysis 
of the laryngeal muscles. The vocal chords, having no longer any active move- 
meat of their own, form a double valve; and are forced together by the col- 
umn of inspired air. The difficulty of inspiration which results is much move 
strongly marked in young than in adult animals. If the recurrent nerves 
be divided upon a pup two or three weeks old, the inspiration becomes at 
once excessively difficult, and has a peculiar choking or sucking character, 
which immediately indicates the larynx as the seat of the difficulty. In older 
animals, the section of these nerves, as Longet has already observed, produces 
less disturbance of the respiration, owing to some anatomical differences in the 
structure of the larynx. According to him, the anterior processes of the ary- 
tenoid cartilages, which form the borders of the glottis in its posterior part, 
are longer in proportion to the vocal chords in the adult than in the young 
animal; so that in the adult, after paralysis of the laryngeal muscles, the 
glottis will still be kept pervious, in a considerable portion of its extent, by 
the unyielding arytenoid cartilages ; while, in the young animal, the flexible 
vocal chords will fall together, and close the opening almost entirely. I have 
not been able to convince myself of this difference in the proportionate size of 
the cartilages at different ages ] though it is very certain that in old animals 
the glottis still remains somewhat permeable after section of the recurrents, 
while in the young it closes much more completely. The difference appears 
rather to be dependent on a difference in the position of the arytenoid carti- 
lages than in their size. 

As the fibres of the inferior laryngeal nerves leave the pneumogastrics in 
the interior of the chest, it is evident that if the latter be divided in the neck, 
a paralysis of the glottis will be added to the other effects of the operation; 
a circumstance which has not been sufficiently appreciated by experimenters. 
The importance of maintaining the respiratory movements of the glottis, in 
the young animal at least, may be understood from the following experiment, 
which I undertook for the purpose of ascertaining the relative importance of 
the recurrent nerves and the other fibres of the pneumogastrics: Two pups 
were taken from the same litter, and of the same size and vigour, about two 
weeks old. In one (No. 1), the pneumogastrics were divided in the middle 
of the neck ; and in the other (No. 2), at the same time, the inferior laryn- 
geal. For the first few seconds after the operation there was but little difference 
in the condition of the two animals. There was the same struggle for breath, 
the same gasping and s?frZ:/;?y inspiration, and the same frothing at the mouth. 



1854.] Morland, Extracts from Soc. for Med. Improvement. 79 



Very soon, however, in No. 1, the respirations became much reduced in fre- 
quency (10, 8, and 5 per minute), as usual after section of the pneuniogastrics, 
while in No. 2 they continued frequent as well as laborious, and the general 
signs of agitation and distress were kept up for one to two» hours. The ani- 
mal, however, after that time became exhausted, cool, and partially insensible 
like the other. They both died between 30 and 40 hours after the operation. The 
peculiar congestion and solidification of the lungs, considered as characteristic 
of section of the pneumogastrics, existed to a similar extent in both ; and the 
only appreciable difference between the two bodies was that in No. 2, the 
blood was fluid, and the abdominal organs congested, while in No. 1, the 
blood was coagulated, and the abdominal organs natural. This experiment 
affords additional evidence of the two following facts, which have been already 
more or less generally acknowledged by experimenters : — 

First. — After section of the pneumogastrics, death is produced by con- 
gestion of the lungs. 

Second. — This congestion is not a direct effect of the division of the nerves^ 
but is caused by the imperfect admission of air into the chest. 



Art. IV. — Extracts from the Records of tlie Boston Societt/ for Medical 
Improvement. By Wm. W. Morland, M. D., Secretary. 

February 13. Imperforate Rectum. — Dr. Parkman reported the case. 
The patient 62 hours old; anus perfectly formed; obstruction of rectum nearly 
two inches within the anus. Dr. P. waited 18 hours, until the septum be- 
came distended by collected meconium, and then punctured tbe pouch with 
a trocar; injecting afterwards, and washing out the bowel. This process was 
repeated, but the opening not remaining free, a director was passed into the 
anus and through the opening made by the trocar, and the sphincter ani and 
the septum were divided, from before backwards, by a free incision ; the fin- 
ger could then be passed, and went into a large cavity. After the operation, 
the child took the breast readily, and is now doing well, three months after 
the operation. Dr. P. directed an attendant to pass a well-oiled finger within 
the opened intestine daily. 

Needles penefy^ating the Knee-Joint. — Dr. J. Mason Warren related three 
cases. The first was a child of scrofulous habit, 5 or 6 years old, who, while 
kneeling on the floor, had a needle penetrate and break off in the knee-joint. 
It was of large size, larger than the ordinary darning-needle. Dr. W. was 
called out of town late in the evening to see this child m consultation. 

On examination, a small aperture could be distinguished below and to 
the inside of the patella. The leg was flexed on the thigh, and fixed in that 
position, so that it could not be extended. Dr. W. thought that the needle 
had penetrated between the two condyles of the femur, and was fixed there, 
and that it was broken off in the joint, as nothing could be felt of it exter- 



80 Morland, Extracts from Soc. for Med. Improvement. [July 



nally. He advised, however, that a dissection should be made as far as the 
capsule, but to abstain from going further unless it could tben be detected. 

This was done, but nothing found. The question then arose whether the 
limb should be left in the position in which it was fixed. Dr. W. advised 
strong flexion and extension to be made, so that in case the body were lodged" 
in the way he supposed, it might either be dislodged or else plough up for 
itself a cavity in the cartilage on the head of the tibia. By these measures 
the motions of the limb were restored. The child was kept perfectly quiet 
for a few weeks, until all inflammatory symptoms had subsided, after which 
he walked about without inconvenience. 

This patient died of phthisis some years subsequently to the accident, and on 
examination of the knee-joint, the following was the appearance : The needle, 
as had been supposed, was firmly lodged between the condyles of the femur; 
it was somewhat corroded; and, from the motions of the joint, it had worn 
and maintained for itself a passage, so as not to interfere with flexion or 
extension. The joint itself was otherwise healthy. 

The second case was that of a child 6 years old. In the summer of 1853, 
a needle, which was sticking in the window-seat, got into the knee-joint. 
It was immediately withdrawn, and the child, not suffering any pain, was 
allowed to use the limb. A few days after, severe inflammation came on in 
the wound, and a fungus shot out. At this period. Dr. W. was called to see 
the patient. The joint was found to be in a very tender and inflamed condition. 
On flexion, a quantity of pus ran from the wound, which was surrounded by a 
fungus of the size of a five-cent piece. Entire rest, with a splint, was enjoined, 
and the fungus was touched with caustic, causing at each application an 
increase of inflammatory trouble. After four or five weeks of treatment, the 
case finally terminated favourably. The needle had entered just on the inner 
side of the ligament of the patella. 

The third instance was observed in a child of 5 years. Kneeling down on 
the floor in front of a bureau, to get something from underneath it, a needle, 
which had been engaged in the carpet, ran into the joint, and broke off" therein. 
When seen by Dr. W. with her physician, Dr. Bail, the limb was painful on 
motion, somewhat swollen, and the child could not walk. By making strong 
flexion, a hard substance could be felt below the patella, on the inside of the 
joint, giving to the touch the sensation of some large body like a nail. 

The patient being etherized, a dissection was made through the skin and 
fat until what appeared to be the capsule of the joint was reached. Within 
this, the foreign substance was felt firmly imbedded. The nails of the two 
fore-fingers were now pressed against it on each side, causing it to project 
through the capsule, when it was seized by the forceps. It was now found 
quite difficult to extract, and this was only done after a number of efforts, and 
by working it laterally, thus disengaging it from the bone. A splint was 
directed, with applications of cold water, and care in diet; her physician pro- 
mising to give information if any symptoms requiring attention should present 
themselves. 

UnumalJi/ perdatent HemorrhaQe. — Dr. STRONG reported the ease. J. Gr., 
■43 years of age, a carpenter by trade, for several years had used spirits freely, 
but for three or four past years had been temperate; for at least twenty years 
has been subject to epistaxis, especially during the summers, as long as warm 
weather continued; he usually bled twice every day, at noon and at night; 
the amount of blood lost was often large, and the bleeding was arrested with 
difficulty. For about the same length of time that this hemorrhage has con- 



1854.] Morland, Extracts from Soc. for Med. Improvement. 



81 



tinued, the patient has been subject to cough, accompanied by copious expec- 
toration ; and, within a year or two, there came on slight^ occasional hsemo- 
ptysis, which was easily stopped by draughts of salt and water; recovering 
from these attacks, he would return to his occupation as usual. Within the 
above-mentioned twenty years, he has had several severe fits of illness, which 
were called " bilious" attacks ; his skin has been more or less yellow for the 
whole period; for about 12 ye9,rs he has been dyspeptic; his food often 
oppressed him; he was an unusually small eater, his favourite food being fresh 
meat without salt; half a pigeon sufficed him for an entire day. His last ill- 
ness was of twenty-one weeks' duration, reckoning from his first calling medi- 
cal aid; but for more than a year previously, he had not his usual health. His 
last attack was catarrhal, with frequent cough and copious expectoration. 
After about eight weeks he so far recovered as, on the 7th of December, to 
go out into the open air for a walk, the midday being sunny and pleasant. 
Soon after returning from his walk, he began to bleed from the lungs, and 
Dr. S. was summoned. Before his arrival, however, the hemorrhage had 
ceased ; about a pint of blood, by estimate, having been lost. A somewhat 
superficial examination of the lungs (Dr. S. fearing to excite a return of the 
bleeding) detected no signs of a cavity or of any marked disease of the lungs. 
The most usual symptoms were shifting pains about the chest and shoulders, 
with a sensation of congestion, more permanent in the prsecordial region, 
attended by stricture, as if a-cord were tightly drawn around him; and this 
latter feeling was at times excessive, especially immediately before an access 
of bleeding. He could, at such times, hardly raise himself erect, but leaned 
forward, with an effort to respire. On examination, the liver was found to 
occupy an unusually large space, and was uncommonly prominent and firm to 
the touch at the pit of the stomach ; tender, and even sore, upon pressure 
being made. From this time, by his own report, there were twenty recur- 
rences of the haemoptysis and seventeen of the epistaxis ; these usually, but 
not always, alternativg. Pulse between 60 and 70 per minute; full and hard 
previous to the hemorrhages, and did not lose this character, even imme- 
diately after them, until within a few days of his death. When about to 
bleed from the lungs (which he could foretell with great accuracy) he had 
increased sense of stricture about the base of the chest, with more pain, and 
that always concentrated in the side of the thorax from which he appre- 
hended the flow of blood. There was usually much febrile action and great 
heat in both the back and front chest ; the bleeding continued until the local 
and general symptoms subsided; relief being very marked; appetite, lost just 
previous to hemorrhagic attacks, would in the intervals return. These symp- 
toms and their relief thus alternated without any special difference. At one 
time, while the patient was complaining of severe pain in the chest, Dr. S., 
on auscultation over the spot, heard a distinct crepitous rale, which, affcer the 
subsequent hemorrhage, had disappeared. Seemingly a transient inflamma- 
tion was established, which at a certain stage, was uniformly relieved by the 
natural bleedings. Epistaxis was preceded by pain in the head and nose, 
with a feeling of fulness and of heat in the nostril from which the blood was 
about to flow ; in these bleedings, the first discharge was of a dark colour, but 
soon it became florid red, with increased sensation of heat. From the lungs, 
the first flow of blood was rather dark, but in a short time it was of a bright 
vermilion; occasionally (and more particularly in the first bleedings), the 
blood was diffluent, and remained fluid; but in the latter attacks it coagulated 
firmly. There was but one discharge of blood per anurm; this he himself 
referred to the fact of having felt much of it run into his throat during epis- 



82 Morland, Extracts from Soc. for 3Ied. Improvement [July 



taxis, and to his swallowing the same. The blood from the lungs was of a 
bright arterial hue, and, mixed with a frothy mucus, came away after cough- 
ing, and did not immediately coagulate. The last recurrences of bleeding 
were on the 10th inst., when it lasted sixteen hours ; on the 12th, about 
twelve hours J and one a few days subsequently, a small quantity. Death 
took place on the 23d of February. 

The patient undoubtedly bled from some general constitutional cause; the 
vital force being depressed in connection with, or perhaps wholly dependent 
upon, disease of the liver and a diffusion of the bile through the circulation. 

The treatment was various ; an effort was made to relieve the system from 
the bilious derangement, but unavailiogly ; astringents in great variety were 
also employed without the least apparent benefit; strict diet, with a like result; 
leeches, blisters, issues were all tried without the least good effect. The bleed- 
ings would recur with nearly the same intervals, whatever was done. After 
very copious hemorrhage, the interval was somewhat longer between two 
attacks. The patient's family estimate the amount of blood lost at more than 
two gallons; there were about forty recurrences of hemorrhage, and the quan- 
tity lost was rarely, if ever, less than a gill at one time, usually being much 
more. Remedial measures being found of no avail, they were finally aban- 
doned, and a generous diet was allowed. Towards the close of his life, the 
mind wandered; a comatose state succeeded, and persisted for about two days, 
when death took place. 

Aiitopuj/j Jive hours after death. — Eigidity slight. At apex of right hni(/, 
posteriorly, was a small cavity, as large as a shagbark, containing pus, and in its 
immediate neighbourhood were a few small, opaque, tuberculous masses. In 
the same lobe, anteriorly, there was a mass of dense, white, or grayish-white 
tissue, occupying about the space of a cubic inch, and having very much the 
appearance of diffused, gray, semi-transparent tubercles. The remainder of 
this lung, as well as the left lung, was considerably congested, especially in the 
posterior portions. There were slight adhesions of both lungs in front, and 
exceedingly firm adhesions of both lungs behind. Two or three ounces of 
serum in each side of the chest. Heart normal; left side contained con- 
siderable liquid blood, which soon coagulated. About four ounces of clear 
serum in pericardium; no adhesions. Licer large, dense, and firm; studded 
and filled with small nodules of yellowish-white colour, probably tuberculous. 
Gall-bladder and bile natural. Spleen quite soft and friable; stomach, kid- 
7iei/^, and other organs healthy. There was some clear serum found in the 
peritoneal cavity, but no injection of vessels, and no adhesions. The blood 
which escaped from the heart, as mentioned above, as well as that which 
escaped in removing the lungs, was at first unusually liquid, but soon coagu- 
lated. No appearance of paleness in any organ, as if from loss of blood. 

Dislocation of the Humerus — Easy Manual Reduction icithout the Use of 
Eiher. — Dr. Cabot called the attention of the Society to a method of reduc- 
tion in cases of dislocation of the head of the humerus into the axilla, viz., 
by standing above the patient, and fixing the scapula with one hand, or by a 
foot placed on the shoulder, and pulling the humerus directly upwards; the 
antagonism of the deltoid muscle is thus avoided, and the bone usually slips 
instantly into the socket. The case which prompted these remarks was that 
of a stout farmer, upon whom very violent efforts at reduction had been un- 
successfully made under medical supervision, in the more ordinary manner, even 
to the extent of excoriating the arm. The dislocation occurred on a Saturday, 
and was reduced, instantlj^, by the above method, by Dr. C., on Sunday, at 



1854.] Morland; Extracts frora Soc. for 3Ied. Improvement. 



83 



the Hospital. Dr. Cabot remarked that he had been for some time in the habit 
of employing this method, and with uniform ease and success, but never before 
in a case in which other efforts at reduction had been made^ he had, conse- 
quently, supposed that his cases had been remarkably easy acd favourable ones. 
The result, in the above instance, had induced him to refer to the method 
employed. 

Dr. J. 31. Warrex said that he had often tried this method, but had not 
always been successful; the want of success arising from the great pain caused 
by the attempt to elevate the arm above the shoulder-joint further than a right 
angle. In one instance, having been unable to reduce the dislocation by 
the ordinary plan, with the heeJ in the axilla, and having sent out for ether, 
while waiting for it, it had occurred to him to try the plan above referred to. 
[The patient was made to kneel upon the floor, the operator standing in 
a chair, and making extension upwards, so as to nearly lift him from the 
ground. The pain thus produced caused some fainting, and the bone was at 
once restored to its place. It was certainly a means always to be thought of 
when the surgeon was without assistance.] 

Dr. Parkman asked if such dislocations were not oJicays easily reducible 
by means of etherization. He had thus found them in his own practice. 
[This was acknowledged; but it was remarked that ether, not being always 
at command, the surgeon usually attempts reduction without waiting for it to be 
brought; and if any one mode^be easier, or more likely of success than others, 
it is desirable to know it.] 

Dr. CoALE referred to a case which he had treated, and in which much force 
had previously been unavailingly used to reduce a displaced humerus; the 
mode advocated by Dr. Cabot, and which was first advised by Mr. Charles 
White, of Manchester, England, about the middle of the last century, was 
wholly successful, and very easily so. [The patient, in Dr. Coale's case, dying 
thirty days after, an opportunity was afforded for examination of the joint. 
For a full description of this interesting case, see Catalogue of the Cabinet, 
Specimen 172, p. 89. Mr. White's method has been revived by M. Mal- 
gaigne and Mr. Syme; the patient is, by them, placed in a recumbent posture; 
the surgeon sits behind him (for good representations of the positions of sur- 
geon and patient, see Druitt's Yade Mecum and Sir A. Cooper's Fractures and 
Dislocations)) the scapula being firmly fixed, "the arm is raised from the side 
and drawn straight up by the head, till the bone is thus elevated into its socket.'' 
(Druitt.) Mr. Fergusson (^Practical Surgery) points out the modifications of 
Mr. White's method, as practised by Malgaigne and Syme. Mr. White sus- 
pended the patient, by the injured arm, from the ceiling. — Secretary.] 

Use of Lemon Juice, and of other Remedies, in Rheumatism. — Dr. PuTNAM 
asked if any of the members of the Society had found lemon-juice to be of any 
service in rheumatic affections. He had observed some beneficial effect, as he 
believed, in the case of a child, but had not often tried it. 

Dr. Storer mentioned the case of a woman, with rheumatism, at the Mas- 
sachusetts General Hospital, who took, at one period, fourteen tablespoonfuls 
of the juice of lemons, daily, and for several days; there was no purging, and 
no abdominal pain; little, if any marked effect upon the disease; in many in- 
stances, no effect at all is observed; in some, it has been thought noticeable. 

Dr. J. B. S. Jackson referred to two or three eases. No effect. 

Dr. C E. Ware gave to one patient one- half a tumbler of lemon-juice, 
daily, for ten days. No effect ; no inconvenience. 

Dr. Shattuck had observed decided benefit from the use of lemon-juice m 



84 



Morland, Extracts from Soc. for Med. Improvement. 



three or four cases of rheumatism. One patient, who had had two attacks, 
found great advantage in taking the juice; colchicum was, in his case, of far 
less avail. In certain cases, Dr. S. had seen no effect whatever from the 
remedy. 

Dr. BowDiTCH had observed no effect from the lemon-juice. Whatever be 
the remedy, if emesis and catharsis be excited, relief is generally afforded. 

Dr. J. 13. S. Jackson spoke of the well-known uncertainty of remedies in 
this disease. 

Dr. CoALE referred to the bad quality of much of the colchicum on sale, 
and to its variable strength. 

Dr. Bethune, when affected with rheumatism, had found he could take no 
more than fifteen or twenty drops of the wine of colchicum without purging 
being induced, and which always aggravated the disease, which he considered, 
in his own case, to be subacute. Dr. B. said that a more accurate and dis- 
criminating classification of rheumatic cases is desirable; some cases yield 
readily to colchicum; others do not, in the least. He had found quinia of 
service. 

Dr. Strong believed that, to do any good by purgation, the latter must be 
very thorough, and to the extent of fdlt/ deariuy the bowels, not merely 
irritating their mucous membrane. 

Dr. Putnam agreed with Dr. Strong as to the efficacy of purgation in rheum- 
atism, and recommended the combination of rhubarb with the colchicum ; the 
action of the latter is better and more thorough. [At the next subsequent 
meeting, Dr. Putnam mentioned a case in which, under the use of purgatives 
and colchicum combined, violent vomiting and purging were induced, and the 
disease was nearly subdued in twenty-four hours. Sulphate of quinia was 
given, in the dose of from 15 to 20 grains, daily, for four days, with marked 
benefit. Dr. Watson mentions the sudden and complete yielding of the dis- 
ease when powerful purgation and emesis are caused by colchicum. (^Practice 
of Medicine.) He adds that, unless the affection disappear after such violent 
action on the alimentary canal, it will be useless to push the colchicum further. 
— Secretary.] 

Dislocation of the Thumb forwards. — Reported by Dr. MiNOT. 

A lad, in running, fell, and was found to have dislocated the left thumb. 
On examination, the thumb was shortened and strongly extended, so that the 
second joint was brought near to the metacarpal bone, and projected obliquely 
upwards. The head of the bone could be felt in the ball of the thumb, in 
front, and a little to the outside of the metacarpal bone; the bones of the 
thumb were, consequently, a little oblique, compared with the direction of 
the metacarpal bone. The second phalanx of the thumb was flexed upon 
the first. 

The patient having been etherized, reduction was easily effected by employ- 
ing extension, with a slight rotary motion. 

Dr. Minot was not aware that this form of dislocation was considered rare 
.until he met with a statement by Nekton (^Elemens de Faiholoyie Chiruryi.cale, 
t. ii. p. 423), that but three examples of it are on record, to which M. Nelaton 
adds a fourth. 

Opiates in Peritonitis and in other Inflammatory Affections. — Dr. J. B. S. 
Jackson met with a physician, while travelling, who mentioned having had 
great success in the treatment of peritonitis by opium, freely used. Dr. J. 
said that he was inclined to believe such a treatment would be very efficacious 



1854,] Morland, Extracts from Soc. for lied. Improvement. 85 

in many inflammatory cases; he instanced pleurisy and rheumatism, and, 
moreover, would have great confidence in such a treatment of non-serous, as 
well as of serous inflammations. 

Dr. HoMANS spoke of the beneficial action on the skin produced by opium 
in many cases; in abdominal tenderness^ with diarrhoea, small, often repeated 
doses are very serviceable. 

Dr. Stoker thought the free use of opium in cases such as Dr. Jackson had 
mentioned, would have a tendency to constrict and dry the skin. 

Dr. C. E. Ware relies upon opium in pneumonia. He thinks that, when 
largely given, it does not constrict the skin, but induces diaphoresis as readily 
and fully as does Dover's powder. He has not bled for many years in pneu- 
monia. 

Dr. Strong often gives opium to the point of incipient narcotism in acutely 
inflammatory cases. He gives the pure opium as well as Dover's powder. 

Doulle, Self-adjusting Stethoscope. — Dr. BowDlTCH introduced to the 
notice of the Society a new stethoscope recently invented by Dr. Camman, of 
New York city. Dr. B. said that heretofore he had no belief in any one form 
of stethoscope being much better than another. Dr. Williams, of London, 
had long since suggested a form, constructed on scientific principles, which, in 
Dr. B.'s opinion, was a shade better than any other, until Dr. Camman's 
was presented to him. Between the value of Dr. Williams's and of Dr. Cam- 
man's no comparison could be made. The instrument constructed under the 
direction of the latter gentleman, intensifies, to an extraordinary degree, every 
sound heard in auscultation. For instance: the puerile respiration of a child 
seems almost like the rushing of a whirlwind. One scarcely believes his own 
senses at the first inspiratory act that is heard. In cases where the healthy 
respiratory murmur is very quiet, perhaps scarcely recognizable by the naked 
ear, or when examined with Dr. Williams's stethoscope, it becomes quite 
manifest while using Dr. Camman's. So with morbid sounds. Dr. B., 
although he had very recently received the new instrument, and was conse- 
quently but little accustomed to its use, had been able to discover rales and 
rubbing sound, only recognizable after the closest attention by the car alone, 
and that too after their presence had been ascertained by means of Dr. Cam- 
man's apparatus. The reasons for this intensity of sound appeared to be chiefly 
two: 1. Both ears of the observer are acted upon at once. 2. The ear- 
pieces of the instrument, fitting tightly into the meatus of both ears, all 
external sounds are more thoroughly cut off, and the mind of the auscul- 
tator is thus forcibly drawn to the phenomena taking place within the thorax. 
By this instrument, moreover, the much mooted question, whether the 
column of air, or the material composing the stethoscope, conveys the sound, 
is decided in tavour of the column of air. The proof of this consists in the 
following facts : 1. Dr. C.'s stethoscope consists of no less than five difi"erent 
media, viz. ebony, an elastic tube lined with metallic wire, metallic tubes, 
and finally, ivory ear-tubes. According to all acoustic theories, such a variety 
of media should not transmit sound as well as a more homogeneous substance. 
2. Dr. Camman, by experiment, found that when the base of his stethoscope 
(i. e. the bell-shaped portion that rests upon the chest) was made solid, cdl 
sound was lost. Dr. B. concluded by recommending the new instrument to 
the candid examination of the members of the Society. 

Tumour of the Breast — Dr. Cabot. — Mrs. M., 40 years of age, first noticed 
a hardness and swelling in the left breast about five months since; it increased 



86 



Morland, Extracts from Soc. for Med. Improvement. [July 



rapidly ; at first with pain, but latterly there has been none. Dr. Cabot re- 
moved the breast on the 11th inst. 

On the 14th, there were cough and some streaks of blood in the sputa. 
R. Pulv. ipecac., Pulv. opii, aa gr, ss. 

11th. Some suppuration under flaps of wound. 

l^th. All sutures came away. 

20^A. Discharge from axillary corner of wound is quite considerable. 
March 1. Dress with spirit and water; patient may sit up, 
3(i. Granulations flabby, dress with resin cerate. 
1th. Granulations more healthy. 
*dth. Discharged, nearly well. 

3Iicroscopic Examination of the Tumour. By Dr. John Bacon, Jr. — < 
Sections from different parts of the tumour exhibit under the microscope a 
dense cellular tissue, with a small proportion of cells and free nuclei, having 
the characters of cancer. In some parts small granular cells, which may be 
epithelium or secretory cells from portions of the mammary gland not invaded 
by the disease; oil-globules and molecular granulations occur as usual. 

Tumour of the Upper Maxillary Bone — Excision. — Dr. J. Mason War- 
ren exhibited a specimen in which the whole maxillary sinus was occupied 
by a tumour of fibro-plastic appearance. Towards the angle of the jaw the 
tumour had made its way out of the sinus by an opening, and insinuated itself 
under the zygomatic process, being firmly attached to the external part of the 
jaw at that point. The history of the case is as follows : — 

The patient is 21 years old, and has just graduated from college. Many 
years ago he had the last molar tooth in the left upper jaw extracted. Nine 
months since, after a fortnight's pain in the face, a small tumour appeared at 
the edge of the jaw, whence the tooth had been removed, which ulcerated and 
extended. In July, an operation was performed to remove the posterior edge 
of the jaw, with the disease, but the wound never healed. Lately, the front 
part of the maxillary sinus had been projected forwards, making quite a pro- 
minence on the cheek. The eye was slightly protruded, and the sight some- 
what impaired. Within two months, a large ulceration, or perhaps it ought 
rather to be called a tumour, occupied the posterior part or angle of the upper 
jaw; its edges projecting so much as to interfere with complete closure of the 
jaws, and requiring to be occasionally trimmed olf, which was done by the 
patient himself, but not without some bleeding. The discharge from the 
tumour was not very copious; hemorrhage took place from it from time to 
time. The finger being carried into the mouth, encountered behind the ulcera- 
tion a rounded tumour, lying close upon the coronoid process of the lower jaw, 
and leading to the supposition that the tumour had made its way out behind, 
from the maxillary cavity. The microscopical examination was of a doubtful 
character, but rather tending to establish the malignancy of the growth. 

The patient being informed of the probable nature of the disease, and that 
it might have already made its way out of the maxillary sinus into the cheek, 
decided, as his case otherwise appeared hopeless, to have the operation per- 
formed, which was done Jan. 28, in the following manner, etherization having 
been first employed. 

An incision was made from midway between the orbit and the ear to the 
angle of the mouth, with the concavity backwards, the better to expose the 
tumour, which tended in that direction. The flaps were rapidly dissected up, 
the large vessels tied, and a freezing mixture applied to the surface so as to 
stop the bleeding from the small vessels; the ether being used at the same 



1854.] Morland, Extracts from Soc. for Med. Improvement. 



87 



time, and the patient again brought fully under its influence. The first in- 
cisor tooth was extracted, and the soft palate, or rather mucous membrane 
covering the hard palate, cut across, where the superior maxillary joins with 
the palate bone. The bones were now quickly divided ; first, the zygoma ; 
next, the external angular process of the malar bonej third, the nasal process 
of the superior maxillary; and, finally, the junction of the two maxillaries, by 
the cutting forceps, one blade of which was introduced into the mouth, the 
other into the nostrils. The whole bone was now seized with strong hooked 
forceps and slightly depressed, so as to expose the superior maxillary nerve 
in the bottom of the orbit, which was divided by the scissors; and, by a few 
more strokes of the knife, the whole mass was removed. Three or four ves- 
sels were tied, but the hemorrhage was not great. 

An examination of the tumour showed it to be of a fibro-plastic character. 
It occupied the whole maxillary cavity, had made its way out behind, and 
turned up on its posterior wall under the zygoma; but it adhered so firmly 
to the maxillary bone as to come out with it enveloped in a cyst. 

The edges of the wound were approximated by sutures, and cold-water 
dressings applied. In a month the patient had so far recovered as to go 
home. Double vision was experienced for some days after the operation, but 
the control of this faculty was soon regained. The loss of sensibility in the 
integuments, consequent on division of the nerves, was partially restored, and 
is constantly improving. 

February 27. ExfoViation from the riylit Loicer Jaw after Extraction of a 
Molar Tooth. — Dr. Morland showed a piece of the lower jaw, an inch and 
three quarters in length, by three quarters of an inch in breadth at the widest 
part, and which comprised several entire alveoli. The patient from whom 
the specimen was taken is a very tall man, of strong constitution, 45 years 
of age. A decayed and ulcerated molar tooth was extracted from the right 
lower jaw after very violent efi"orts, by a dentist, on the 15th of December, 
1853 ; the crown being broken off, after using two instruments, and the roots 
pried out by main force afterwards. Pain and swelling, which had, to some 
extent, previously existed, continued and became aggravated after the above 
operation, and extended to the neck. The patient, finding two sound teeth 
loose in the vicinity of the former, took them out himself easily; and, on the 
2d of January, perceiving a portion of bone loose in the site of the extracted 
tooth, he used a penknife as a lever, and turned out the specimen shown. 
Pain and swelling somewhat abated afterwards, but a numbness " of the lip 
and of three front teeth," as the patient describes it, followed — with shooting, 
neuralgic pains, particularly when the head was inclined to the right side. ♦ 
An aggravation of the pain and swelling occurred January 24, the latter in- 
creasing until it extended from the eye to the collar-bone, accompanied by 
soreness of ^the throat, loss of power of articulation, and great diflSculty in 
opening the mouth. This state of things was relieved after profuse discharge 
of pus by the mouth, seven or eight days from the recrudescence of the trou- 
ble. Shortly after, pus in large quantity was evacuated externally from just 
beneath the right lower jaw. Convalescence was gradual after this; the 
patient has been, for a period of nearly three months, almost wholly incapaci- 
tated from attending to his business, and for nearly that time has suffered 
pain and excessive inconvenience in deglutition, articulation, &c. His coun- 
tenance has a pale, sallow hue, and plainly indicates that his system has felt 
the effects of the injury very severely. Several smaller pieces of bone came 
away during the above period. Dr. M., considering the amount of injury 



88 Morland^ Extracts from Soc. for Med. Improvement. [July 



and disturbance unusual from so common an operation (although much vio- 
lence was used), inquired particularly as to the patient's occupation, and 
whether there were anything to which he was exposed likely to affect the 
bones. He is occupied in a chemical laboratory; he states that he has never 
been exposed to the fumes of phosphorus in a free state; has had much to do 
with the various 'pliOi^i:ilmte8 ; has dealt largely in muriatic acid, but is un- 
aware of any ill effects therefrom; he is quite confident, however, that the 
being so much in an atmosphere of hydrochloric acid vapour has caused ex- 
cessive hanneiis in his case, and believes it always does so; patient has manu- 
factured iodine, largely; has often been troubled by its irritant effects on the 
air-passages — not otherwise, that he is aware of; has handled pyroligneous 
acid in large quantity. 

May 1, 1854. — Patient reports that the numbness (termed by himself 
paralysis,^' and consequently it must be a marked sense of benumbing) of 
the lip and chin still continues, and that there is also pain in the jaw, at times 
severe; the whiskers refuse to grow upon the right side, over the seat of 
injury, which, as the patient remarks, gives him a rather "sinister look.'' 

Cancerous Disease of the Rectum and Vagina. — Dr. MiNOT reported the case. 

Mrs. G , set. 48, laundress, widow, having borne four children, had 

always enjoyed good health until June, 1853, when she began to have, with- 
out known cause, frequent, small, bloody, painful dejections, accompanied by 
much tenesmus and dysuria. She had perceived a tumor in the abdomen for 
some months previously. 

On the 20tli October, when she applied for relief, she was pale, sallow, and 
feeble, with a clean tongue and a pulse of 94. She had been losing, according 
to her own statement, half a teacupful of blood by stool daily. The discharges 
from the bowels were scanty and clay-coloured, and there was a frequent desire 
to pass urine, and difficulty in voiding it. On examination per rectum, the 
caliber of the intestine was almost blocked up by a large, smooth, irregular 
mass, apparently covered by mucous membrane. Per vaijinam, a similar 
state of things existed, the canal being obstructed by smooth, irregular masses 
of cartilaginous hardness, which projected into its caliber. The os uteri could 
not be felt with certainty. The diseased mass was not movable, and gave no 
pain when pressed by the finger. On palpation of the abdomen, a smooth, 
hard, round tumour of the size of an orange was felt in the left iliac fossa. 
It was movable, and shifted its position with the motions of the patient. 

Until her death, which took place Feb. 19, 1854, Mrs. G. had a constant, 
profuse, offensive discharge from the vagina, which was generally dirty-coloured, 
sometimes bloody. There was also frequent desire to empty the bladder, and 
difficulty in doing so. She had little or no pain except during her last few 
days, though she occasionally complained of much uneasiness or distress in the 
abdomen. The bowels were costive early in December, the discharges from 
the bowels began to come per vaginam, and, on examination, a large commu- 
nication was found between the vagina and rectum. She menstruated regu- 
larly, her last period beginning January 28. During the last fortnight she 
vomited everything taken into the stomach, though nothing was found in the 
appearance of the organ after death to account for this symptom beyond in- 
jection of the cardiac extremity, and an extremely corrugated state of the 
mucous membrane. The liver was large, fawn-coloured, fatty, and contained 
much fluid blood. The gall-bladder was greatly distended with bile. 

Dr. J. B. S. Jackson, who examined the diseased pelvic viscera, gave the 
following account of the appearances :— 



1854.] Morland, Extracts from Soc. for Med. Improvement. 



89 



On disvsection, there was found deep ulceration of the rectum, and of a well- 
marked malignant character, commencing about an inch from the anus, ex- 
tending upwards two inches or more, and involving the whole circumference 
of the intestine. The cellular tissue was affected so that the parts were very 
firmly bound down to the sacrum. The disease extended also to the upper 
part of the vagina, and there was a direct opening into it from the rectum, 
effected by the process of ulceration, and sufficiently large to admit two fingers. 
The OS uteri was somewhat ulcerated, but the uterus itself was not much dis- 
eased. The whole posterior half of the bladder, however, was very much 
thickened and indurated, having generally a scirrhous appearance, without 
any encephaloid deposit, which last was quite marked in some parts of the 
rectum ; the inner surfoce was red, roughened, and evidently inflamed, though 
nowhere ulcerated; otherwise, the bladder was perfectly healthy. 

Tumour connected with the Cerebellum. — Dr. J. B. S. Jackson reported 
the case, of which he had lately made the dissection. The mass was about 
the size of an English walnut, perfectly defined, firm to the feel, partly made 
up of three or four small cysts, and partly of a solid whitish substance. Ex- 
ternally, it was somewhat lobulated, traversed superficially by large thin 
vessels; and the whole appearance, externally and internally, was such as 
to suggest the idea of malignancy, though nothing was discovered by the 
microscope to favour it. The Jumour was connected with the under surface 
of the right lobe of the cerebellum, and appeared to have been formed in the 
pia mater. '1 here was a very large serous effusion in the lateral ventricles, 
as usual in such cases ; and the fifth ventricle was observed to be particularly 
dilated. The brain itself was healthy. The patient was a middle-aged man, 
and by profession a clergyman. Deafness in the right ear w^as observed two 
years ago; and the tumour may then have been of some size, though no other 
symptoms occurred until the following autumn. Then there came on occa- 
sional paroxysms of headache and vomiting; and this last was a very marked 
symptom throughout most of the disease. Last summer the gait became 
unsteady, and there was towards the last much loss of power, though it was 
never complete. The intellect also became dull, and since last October, when 
he gave up his professional duties, he was mostly, if not entirely, confined to 
the house. 

Dr. ISargent, of Worcester, who was present at the meeting of which the 
above report was made, spoke of a patient whom he had attended, a lady, 52 
years of age, who had loss of memory, some vertigo, slowness of speech with 
miscalling of words, opisthotonos, and, finally, paraplegia and complete de- 
mentia. Dr. S. supposed that he should find, at the pos^w«o?Ve??^ examination, 
softening of the brain and some affection of the spinal marrow. The patient 
was ill for from six to eight weeks; on necroscopic inspection. Dr. S. found 
the substance of the cerebrum the hardest he had ever seen, and the spinal 
marrow was perfectly healthy. 

Dr. S. remarked further of this woman, that, although she was only 52 
years of age, and had scarcely ceased to menstruate, she had the whole ap- 
pearance of extreme old age. She had also recently experienced a great 
deal of domestic trouble. 

Ulceration of the Knee-Joint — Amputation . — Dr. Cabot showed the parts 
removed, and gave a history of the patient, a girl, 16 years of age, who entered 
the Hospital, April 26, 1853, with disease of the knee-joint of four years' 
duration. She first observed slight enlargement of the right knee without 



90 Morland; Extracts from Soc. for Med. Improvement. [July 



known cause; it has never incapacitated her for working or for walking; there 
has never been pain in the joint except when she was overworked. At the 
time of her entry at the Hospital, the motion of the joint was limited; the 
head of the tibia much enlarged; circumference of the joint at upper part of 
patella fourteen and a half inches, the same at the middle, fourteen inches at 
the lower part. Blisters, tincture of iodine, and water-dressings were applied 
until the 29th of May, when there were indications of abscess forming in the 
popliteal space ; swelling, with fluctuation, &c. Poultice. 

June 11. Abscess opened last night, and is now discharging pus and clots 
of blood. Poultice continued. 

JaJt/ 6. Abscess injected with tincture of iodine; a knee-cap was used to 
support the joint and prevent motion; liniments; issues over the condyles of 
the femur; tonics internally, &c. 

Nov. 20. Patient etherized and the sinus examined; it was found to extend 
around to the front side of the knee, where there was a large cavity; an inci- 
sion was made over the site of said cavity and pus was discharged. Flaxseed 
poultice; much pain; opiates were applied locally and given internally, also 
stimulants. 

23c?. Abscess beneath knee-joint opened. Diarrhoea supervening on the 
29th, was met by a tonic and astringent combination. Cod-liver oil was 
afterwards administered. 

Fthnmrij 18, 1854. The limb was amputated by Dr. Cabot. 

Dr. J. M. Warren, referring to this case, spoke of its earlier aspect, &c. ; 
there was, at first, only a small bunch upon the knee, which, when opened, 
discharged serum; an abscess, as above described, subsequently formed ; the 
diagnosis was at first difficult; no dead bone was detected; the muscles were 
found, on removal of the limb, in a state of fatty degeneration. 

Dr. J. B. S. Jackson spoke of the soft, flesh}^, membranous, red formation 
sometimes observed on denuded bones; he asked if this were not often de- 
scribed as a pulpy degeneration of the synovial or investing membrane'/ May 
it not, rather, be frequently only the granulations of inflamed bone? 

March 13. Litermittent Headache. — Dr. C. E, Ware reported two cases of 
this affection, relieved by opium. The first was in a young woman who was 
sufiering from amenorrboea following typhoid fever. The headache had con- 
tinued very severe for more than a fortnight, during which time she had tried 
quinia, iron, and arsenic in full doses. She had been leeched and blistered ; 
nothing seemed to make the slightest impression upon the disease. The 
headache commenced in the morning and continued till evening. 

She began to take opium in two grain doses the sixteenth day of the 
disease. Soon after, she became easy, and then continued the pills through 
the day often enough to keep her fully under the influence of the opium, and 
to insure freedom from pain. She was obliged to continue the pills more or 
less frequently for two or three days after. She never, however, after the 
first pill, had any serious return of the headache. The irregularity in her 
, catamenia continued. She experienced no unpleasant efiect from the opium. 

In the other case, the aflFection occurred in an old lady, 87 years of age. 
She was a vigorous woman for her years, and was well, except for the headache. 
She tried for several days quinia and iron, without the least benefit. She 
took opium in similar doses to those of the first case; was relieved by the 
first pill, but was obliged to keep under the influence of the opium for a day 
or two. She had no serious return of the headache. 



1854.] Morland, Extracts from Soc. for Med. Improvement. 91 



TithercidoHs, etc. — Dr. BoWDiTCil was called, Ftbruari/ 26, 1854, to see 
B. M., male, set. five months. Some months since, the boy fell from his cradle 
and struck upon his head. No serious trouble remarked, and no manifest con- 
nection of the fall with present disease. For two months previous to present 
illness, he had had a pustular eruption on various parts of the body, and had 
drooled'^ much, as if troubled by dentition. Both of these affections disap- 
peared on the occurrence of tbe present attack. For a fortnight before Dr. B. 
saw him he had not been quite well, as his mother thought, although he had 
had no evident illness, except that, about the middle of that time, the child, 
while nursing, seemed suddenly distressed ; at these accesses, he would throw 
his head backward, and seemed faint and gasping, with the eyes rolled up. 
These lasted only a moment, and immediately he would recover and seem as 
well as before. They occurred, however, only a few times, and, as no other 
symptom appeared, little was thought of them except by the anxious mother. 
On '22d or 28d, he occasionally moaned as if in pain, and a slight torticollis 
to the right side was noticed. When Dr. B. saw him, he had then turn of 
the neck permanently, but in a slight degree. No swelling, tenderness, or 
redness apparent, but the child seemed to suffer when any manipulations were 
made on the neck. Little appetite, no vomiting. Respiration regular, but 
with a constant moan. Pulse not slow; skin of moderate temperature. Calo- 
mel gr. i. ordered; and Dover's powder \ gr. at night and morning. 

Restless night. At visit, sleeping quietly. Pulse 130. In addi- 
tion to the Dover's powder, 10 drops of paregoric had been given three times. 

28i'/i. Easier night. One powder only taken. At visit, brighter, but had 
refused to nurse, and had been fed with breast milk which he took with 
avidity. Very irritable ; no strabismus ; had had four attacks similar to 
these above described. Apparently a little tenderness about right ear. Pulse 
regular, quick; respiration easy; no vomiting. A leech below right ear. 

Patient remained in the same state, and next day Dr. Channing saw him 
in consultation and advised— Potass, hydriodat. gr. iv. ; in simple syrup Jij ; 
3ss to be taken once in six hours. Cold water to the head if much suffering. 
Paregoric, if severe suffering at any time. 

March Sd. Patient has been more quiet. Had frequently moved right 
arm and rubbed hand upon same side of the head and right eye; the accesses 
of increased suffering less severe, at times low moaning ; neck less stiff and 
right limbs which had at times been restless, were less so. Right fist firmly 
contracted; thumb bent inward on the palm. Frequent gaping. No real 
vomiting, but some retching; eructations of flatus after food; no dejection. 
Urine, in quantity rather more, and less ammoniacal in smell than it had pre- 
viously been. Pulse rapid and small. 

On 2d, Dover's powder and calomel had been ordered occasionally. Con- 
tinue them and iodide of potassium as directed. 01. ricin. 5j- 

The disease steadily advanced. Night of 4th, quiet. 5th. Restless under 
a domestic remedy and without opiates ; subsequently, not very uncomforta- 
ble nights till 10th, when he died in convulsions. Previously, he was quite 
irritable at times, and screaming as if in pain. On the 4th, the eyes tended 
to the left. There was frequent motion of the right extremities, a partial loss 
of power in the left ones. The pupils, which were at one time contracted, on 
4th were larger. On 7th, strong strabismus. On 9th, deep stupor. On 4th, 
the breathing was deep, rather slow, and uneven. Occasionally a slight hack, 
but no severe cough was heard at any time. No other rational, and no dis- 
tinctly morbid physical, signs referable to the lungs. Pulse on 4th was 128, 
on 7th, 100. Urine was augmented on 6th. Some tendency to occasional 



92 



Morland, Extracts from Soc. for Med. Improvement. [July 



retching, and a day or so before death vomited a few times. During this 
period, the same medical treatment was continued except on 6th ; 1 gr. of 
potass, nitrat. was ordered at intervals. 

On 10th, the report was, that, after lying for the previous thirty-six hours 
in more or less stupor, accompanied by evident prominence of the anterior 
fontanelle and constant strabismus, but with a less firmly contracted fist, he 
died in convulsions. At 6 A. M. of 10th, autopsy., twenty-six hours after 
death ; meninges of the brain very much distended, owing to a large quantity 
of thin, rather turbid, fluid in ventricles, which, under the microscope, con- 
tained pus and exudation corpuscles, and apparently detritus of the cerebral 
substance. Numerous minute (tubercular) granulations in the anterior com- 
missure, and over the base of the brain. Recent lymph around the optic 
nerves. The interior of the left hemisphere was broken down by the scalpel 
throughout a large part of its extent, and a soft white detritus, save in one 
part, involved the corpus striatum and optic thalamus, and wall of the ven- 
tricle. Here the cut surface had a hard, tubercular aspect. Bronchial 
glands, tuberculous; minute semitransparent granulations were found filling 
the lungs. They were likewise numerous in the liver, less so in the spleen; 
a few in the kidneys and intestines; and, finally, two or three, unequivocal in 
their character, were found on the left ventricle of the heart, just under the 
pericardium. The voluntary muscles, so far as examined, contained none. 

The very insidious nature of the attack, the torticollis, and the universal 
distribution of the tubercles, Dr. B. regarded as the peculiar points in the 
case. 

Blighted Ovum. — Dr. W. E. TowNSEND exhibited a blighted ovum of about 
three months' growth. This was cut open. The umbilical vesicle was very 
distinctly seen, and the walls of the structure were very thick. Dr. T. re- 
ported the following history of the case: " Was called on Wednesday last to 
see a lady, who stated that she was that day taken with a slight flowing, 
unaccompanied by pain ; that she supposed herself to be between three and 
four months pregnant ; that on Saturday night, two and a half weeks pre- 
viously, she had slipped down two or three steps at the Fitch burg Hailroad 
station-house, and jarred herself severely, so that, whilst riding home in an 
omnibus, she suflered greatly with pain in her back; the next day, however, 
she experienced no inconvenience from her fall, but went to church as usual. 
From that time, the morning sickness and occasional faintness, which had 
been prominent symptoms of pregnancy with her, disappeared, and she had 
felt entirely well till the present occurrence. Horizontal posture, and other 
appropriate remedies, were tried without avail; and, on Sunday afternoon, after 
suffering severely, she miscarried, three weeks and a day after her accident." 

Spleen enlarged ; not the Result of Fever. — Dr. Jackson exhibited the 
specimen and reported the case, which he thought interesting from the cir- 
cumstance of so many of the same kind having occurred here; the organ, in 
such cases, weighing several pounds, and being rather firm to the feel, whilst 
the patient had never had intermittent fever, and, in several of the cases, had 
never been in any part of the country where this form of fever prevails. The 
weight, in this instance, was between four and five pounds, the density was 
very considerable, and the enlargement had existed for some months at least. 
The patient was a middle-aged man, and died of a pulmonary affection of 
short duration. 



1854.] Morland, Extracts from Soc. for Med. Improvement. 



93 



Iritis terminating in Stapliyhma — Dr. E. TV. HooPER. — Three cases of 
inflammation of the iris, terminating in staphyloma of the eye, have been seen 
at the Massachusetts Charitable Eye and Ear Infirmary in the last two years. 
They were in Irish patients, one male and two females, between the ages of 
eighteen and twenty-four. 

In the first two cases the eyeball was removed on account of the severe 
sufi"ering attending the disease, and its doubtful character. As these two cases 
terminated favourably, and after the interval of two years the patients re- 
mained well, the operation in the third case was limited to a removal of the 
anterior half of the eye, to which the disease seemed principally confined. 

In these cases, the first departure from the usual appearance was in the 
iris becoming of a bright yellow colour, and receding from the cornea; the 
anterior chamber then became turbid, and the sclerotica yielded near the 
margin of the cornea, and irregular dark gray masses protruded. 

Grreat pain attended this stage of the disease, not relieved by puncturing 
the globe ; and the operation for removing the eye in the first two cases, its 
anterior half only in the last case, was followed by entire relief. The patients, 
at the time of the operation, were under the influence of sulphuric ether. 

Since the above was written, the last patient died with disease of the 
brain at the Massachusetts General Hospital. No return of disease of the 
eye after the operation. An autopsy was refused. 

Gleet, its Treatment, &c. — Ur. CoALE read the following remarks: A paper 
by Mr. John L. Milton, in the Medical Times and Gazette for May, 1853, on 
the treatment of gleet, has suggested some remarks on this disease. Mr. Mil- 
ton divides gleet into three kinds: 1. Dependent upon structural changes 
or incipient stricture. 2. Gleet not dependent on these changes. 3. Gleet 
arising from disorder of other structures — the prostate gland, testicle, &c. 
For practical purposes, I would make a different division — retaining, however, 
the last, and particularizing other gleet, as to whether it be purely a chronic 
affection, or whether with it there be more recent gonorrhoea. In the third 
species of gleet — that from affection of other parts of the genito-urinary appa- 
ratus — the treatment must evidently be directed to the affected organ rather 
than to the lining of the urethra. In the other varieties, the difference of 
treatment I make is this: when more recent gonorrhoea accompanies it, in- 
ducing an acute or semi-acute inflammation, the astringent injections, so useful 
in a purely chronic case, are hurtful. In these, then, I substitute warm water, 
or warm mucilaginous injections, and am more particular about the diet until 
all the recent inflammation is wholly subdued ] this effected, resort may be 
had to astringent injections with benefit, and should be continued until every 
trace of the disease is obliterated. In using the injections, the effect of habit 
must be remembered, and the active agent of the injection changed as soon 
as its power seems to decline. Mr. Milton attaches much importance to the 
use of blisters in gleet, and argues for them as if they were a new remedy, 
of which the effect might be doubted. I some time since found out their effi- 
cacy in this disease, and have used them freely; indeed, they constitute an 
important part of the treatment. In very severe cases, I use the blistering 
tissue, applying it to the inside of the thigh, or to the pubis, or even to the 
root of the penis itself; but in most cases this is unnecessary, and instead, I 
use the strong tincture of iodine. The patient is directed to paint a strip on 
the under side of the penis from the root to the glans, bounding one edge 
of the strip by the median line. This painting is renewed sufficiently often 
to get up a vesication. When this surface becomes too sore, it is permitted 
No. LY.— July 1854. 7 



94 Morlandj Extracts from Soc. for Med. Improvement. [July 



to healj and another strip is painted on the other side of the median line. lu 
this way, alternate blisters can be kept up for any length of time. As to 
internal remedies, the difficulty of getting a patient to take any of the dis- 
agreeable mixtures prescribed, long enough to do any good, has occurred to all 
who have had to deal with the disease. Some tasteless and convenient remedy 
is wanted ; this, I think, I have contrived : Bals. copaiva and pounded cubebs 
are made into a mass together, and divided into pills. These can be coated 
with gelatin. They permit the dose to be regulated very conveniently; from 
three to four, taken four times a day, generally being the amount given. 

Popliteal Aneuriam — Dr. J. Mason Warren reported the case of a black- 
smith, 30 years old, to whom Dr. W. was called by a distinguished physician 
in a neighbouring city. In September, 1853, this man perceived a small 
pulsating tumour in the upper and back part of the left leg. This increased 
slowly to the size of a hen's egg. The knee was bent, and he was obliged 
to walk with a crutch. The foot was swollen, its motions partially lost, and 
it was excessively painful. The patient being informed of the dangers of the 
operation by ligature of the artery, the possibility of paralysis or sloughing of 
the limb consequent upon it, and of the alternative of the treatment by com- 
pression, decided on the former; as he was out of town, could not well leave 
his family, and it was impossible to have the compression satisfactorily con- 
ducted at home. 

The feifioral artery was therefore tied at the middle of the thigh, and the 
pulsation of the tumour was at once arrested. The patient was directed to be 
kept in bed, artificial warmth to be applied if necessary, and, in case of great 
reaction — the patient being very muscular — blood to be taken from the arm. 
For a week or two after the operation, the numbness of the foot was mnch 
increased, though the pain was relieved. The ligature separated in sixteen 
days. The patient was seen by Dr. W. some months after, when he was able 
to walk, having recovered the use of the limb. A small, hard tumour existed 
at the place of the former aneurism, having an apparent pulsation, which, 
however, after repeated examinations, seemed to result, and to be communi- 
cated from, an enlarged collateral vessel. He was directed to keep still, avoid 
animal food, and to do nothing that might excite the arterial action. 

By recent reports he is quite well. 

Herpes Preputialis; Case and Treatment — Dr. Bethune. — A gentleman, 
from 20 to 25 years of age, presented himself in the early part of February, 
with this disease. It first appeared after a single exposure last May. He 
had been under the care of several physicians, who were well-educated men, 
and had been severely treated. Among other things had had mercury to 
salivation, and several times had been pronounced cured. The disease has 
returned five times. The present attack had existed two weeks, and was 
marked by several vesicles, or rather the remains of them, situated on the 
inside of the prepuce, near the glans. He was directed simply a saline laxa- 
tive every third day; lint dipped in a solution of acetate of lead placed be- 
tween the prepuce and glans, and strict diet. On the week following, the 
compound rhubarb pill was substituted for the salts, and, soon after, the 
strength of the lead solution increased. March 12, he appeared quite well, 
having been two weeks longer than ever before without a return of the dis- 
ease, A solution of tannin was ordered to replace the lead — and vegetable 
diet. In the early part of April, he was obliged to fulfil a matrimonial 
engagement which had been thrice postponed. This was followed by a slight 
return of the disease. 



1854.] 



Morland, Extracts from Soc. for lied. Improvement. 



95 



March 27. Bezoar. — Dr. GouLD exhibited a ver}^ beautiful specimen of 
bezoar, presented to the Society by Mr. Emery Souther, apothecary, of this 
city. It was taken from the stomach of a deer killed at the mouth of the 
Mississippi liiver. Dimensions: 2 J, Ij, 1^ inches. Weight: 2 oz., 2 drs. 

The thanks of the Society were voted to Mr. Souther. 

Dr. Bacon, who had examined the concretion at Dr. Gould's request, 
stated that it consists of layers of diphosphate of lime, with organic matter, 
deposited around an angular nucleus which appeared to be a fragment of 
pottery. 

[In the report of Dr. Bacon's analysis of a "factitious bezoar," (Dec. 12, 
1853, see No. of this Journal for April last, p. 346,) the following should 
have been added : " The organic matter is ver}^ soluble in water, and appears 
to be a vegetable extract. It contains neither ellagic nor lithofellic acid, and 
there is no doubt that the supposed bezoar is factitious.'^] 

The following paper was prepared by Dr. W. J. Burnett, and was read to 
\ the Society by Dr. Bethune. Kemarks relative to the proposed operation 
are appended: — 

Recommendation of an Artificial Cornea as a Substitute for the Transplant- 
ation of the Cornea,. By JoH. Nep. Nussbaum, Assistant Physician in the 
General Hospital at Miinchen.* The object of this article is, as its title indi- 
cates, to show the advantages, or rather the full success attending the intro- 
duction of an artificial corneaT composed of glass, in those cases where there 
is more or less blindness from opacity of the cornea. 

It is not necessary to give a translation of the entire article, and I shall 
quote only those passages which contain the gist of the subject. 

After alluding to the many contingencies for failure attending the bold prac- 
tice of Himly, of transplantation of the cornea, even by the most skilful 
operators upon the eye, he says he was led to make experiments relative to 
what substances would be least offensive as foreign bodies in the healthy tis- 
sues, in view of using such for an artificial cornea. After experiments upon 
his own body, he found that, of many solid substances, glass produced the 
least irritation, and in some instances scarce any at all. With this fact ob- 
tained, he formed a circular cornea of glass, perforated by a hole two- thirds 
its width. This he introduced into the eyes of dogs, having previously removed 
a corresponding portion of the cornea. But it was attended with no success; 
for, aside from the extreme difficulty of removing a portion of the cornea 
exactly the size of the artificial body introduced, there was much disturbance 
following the introduction of so large a body in so delicate a tissue, such as 
suppuration, &c., with a loss of the eye in the end. 

Thus foiled, he says it all at once flashed upon his mind that an orifice, of 
the size of a pin-hole, is sufficient to admit a good image of an object, if the 
eye is placed directly near it; as, for instance, in looking through such a small 
hole in a piece of pasteboard. With this valuable hint, he made a new trial, 
forming the artificial cornea after a new model, and of a much smaller size. 
Its general form was much like that of a shirt-stud, there being a main shaft 
with a rim on each end ; but, instead of being round or circular, both shaft 
and rims were compressed laterally, being, therefore, of an oblong instead of 
a circular form. The artificial cornea, thus formed and shaped, was not much 

* Die Cornea artificialis als Substitut fiir die Transplantatio Corneas empfolilen. 
Von Job. Nep. Nussbaum. z. Z. Assistenz Arzte im allgemeinen Ki*ankenliause zu 
Miinchen. From Siebold and Kolliker's Zeitschrift ftlr wissenscliaftliche Zoologie. V. 
December, 1858, p. 179. 



96 



Morland, Extracts from Soc. for Med. Improvement. [July 



Fig. 1. 
I la 




larger than the head of a large pin, and perforated by a hole of an oblong shape 
and of a correspondingly minute size, as will be seen in the annexed figures. 

With this new model for a cornea, he pro- 
ceeded to operate upon the eyes of some 
puppies. Instead of making a circular in- 
cision, as in the first experiments, a simple 
slit only was here required. In this slit of 
the cornea, the new body was introduced ex- 
actly as a shirt-stud is put in a shirt. 

The following is his description of the 
operation : — 

"For the operation ' are required, a cata- 
ract knife, a pair of small anatomical forceps, 
and, for the emergency. Cooper's scissors. 
In the absence of a good assistant, there is 
needed a lid-holder of Kelley Snowden, and 
when the eye is very restless, a sharp hook. 
For the patient, I choose the reclining, and 
for the operator the sitting position. The 
pupil being dilated by a strong solution of 
the extract of belladonna, I narcotize the eye 
until the bulb remains quiet; then, opening 
the lids by means of a lid-holder, 1 place 
the cataract knife, which I hold as a pen, at 
right angles on the surface of the cornea, at 
about one-eighth of an inch from its exter- 
nal border, with the knife's edge directed 
towards the inner (not the outer) canthus, 
whereby both borders of the wound are made of equal thickness. I then 
plunge the knife into the cornea, until it reaches the anterior chamber; then 
holding the instrument at a somewhat obtuse angle, I carry it inwards, making 
an incision one-eighth of an inch in length. The knife is then withdrawn 
from the wound by carrying it backwards. 

" As the wound is small, it gapes open but little, and the aqueous humour 
flows out very slowly; but, quick as possible, I seize the glass cornea with the 
pincers, and insert it in the incision, as a button in a button-hole. All this 
insertion must be done very quickly, for upon the time occupied depends the 
reaction and disturbance which are to follow. In conclusion, I remove the 
lid-holder, and glue up both eyes. 

" The quantity of aqueous humor that escapes during the operation, is in exact 
ratio with the disturbance and trouble that follow. When little escapes, the 
iris is little irritated, and the lens but slightly disturbed. In some instances, 
I was fortunate enough to lose only two drops of the aqueous humour; these 
cases healed very quickly, and I was convinced that neither iris nor lens had 
been at all disturbed. In those cases where the incision was too large, and 
did not hold the glass, the operation proved a failure, and I sealed up the eye, 
allowed the wound to heal, and afterwards operated again with better success.'^ 
I need not here give the after-treatment, as laid down by the author. It 
must vary, of course, according to the patient, and the care with which the 
operation is performed, and will suggest itself^pro re nata, to every intelligent 
oculist. 

In regard to some of the sequelae, he says : " In all cases, there appeared, 
on the first day, a universal conjunctivitis, and a ceratitis, with some disturb- 



Fig;. 1. Glass body, natural size. a. 
Front Tie'w. b. Lateral yiew. 

Fig. 2. Eye of a puppy, several weeks 
after tlie operation, with glass body in 
cornea, matrnified 3}^ times, o. Glass 
body. b. White opaque circle around 
glass, c. Remainder of pupil, d. Iris, 
e. Sclerotica. /. BloodTessels on cornea. 



1854.] Morland, Extracts from Soc. for Med. Improvement. 



97 



ance of the cornea; in several cases, an onyx. The former disappear quickly; 
and the abscess of the cornea heals usually in eight to fourteen days, when 
the glass, inclosed in an exudation, ceases to be objectionable to the cornea. 
Iritis I have observed only when the operation was so conducted that much 
aqueous humour was lost and the lens impinged upon. 

" In regard to the appearances in general, my patients seemed as free from 
pain after the eighth day as before, and the general aspect of the cornea ap- 
peared much less disturbed than in those cases where a portion of the cornea 
was removed (as in transplantation of the cornea). The aj)pearance of the eye 
is not particularly bad ; around the glass there is a small, white, opaque circle, 
to which extend, from the border of the cornea, one or two small bloodvessels. 
The eye has no irritability, and no photophobia even to glaring light.'' 

As to the intimate changes which ensue in the tissue of the cornea, from this 
operation, the author says : ^' The sections which I have made during the various 
stages of healing, presented anatomical changes corresponding to the different 
sequelae. The perfectly healed cornea I have often observed microscopically. 
I found the fibres in the vicinity of the glass always more or less troubled, and 
slightly lengthened; close to the glass, they presented a wave-like aspect, and 
their usual parallelism was wholly wanting." 

Such is a brief abstract of Nussbaura's account of his new operation. As 
yet, his experiments have been only upon the lower animals, and the success 
he has had with dogs makes him confident of a like result in man. 

The artificial cornea must, of course, be made with great care, and its size 
and various proportions varied according to the eye to receive it. The author 
recommends the rock-crystal as the best material out of which this body is to 
be formed. 

These experiments, from their success, have excited no little attention in 
the locality of their occurrence, and Von Siebold, a name too well known in 
science to require mention here, and one of the editors of the journal in which 
this article was published, carefully examined some of the dogs operated upon. 
He was surprised to find so little disturbance from the foreign body. Indeed, 
he says, the animal suffered no inconvenience, the secretions of the eye were 
not diminished or increased, and the animal winked, or otherwise used the 
organ, as in the natural state. He considered the subject of sufficient im- 
portance to have a lithographic plate made of one of these animals, with 
details of the parts. At all events, the subject is not lacking in ingenuity; 
and it having been shown that a perforated glass body, of small size, can be 
introduced in the cornea, and there remain harmlessly — this, certainly, is an 
important fact learned; but the application of this operation ' upon man can 
alone determine the visual relations of this body, and the greater or less degree 
which its orifice can transmit rays of light for the formation of an image on 
the retina. Certain it is, however, that the optical principle here adopted is 
sound in theory. 

Dr. Bethune, though he agreed with Dr. Burnett in the opinion he ex- 
pressed of the great ingenuity shown in this form of artificial cornea, yet thought 
its practical utility extremely doubtful. The aperture which forms the pupil is 
made so small (probably to retain the aqueous humour by capillary attraction) 
that a very perfect adjustment must be made and retained, or vision will be 
prevented. So small an opening would be liable to become clogged either 
with foreign substances, or with the secretions of the eye itself, and in getting 
rid of this obstruction by passing it into the anterior chamber, there would be 
danger of exciting destructive irritation of the organ. After much difiiculty, 
Mr. Griffiths, a glassblower of Koxbury, has succeeded in making for Dr. 



98 



Morland; Extracts from Soc. for 31ed. Improvement. [July 



Bethime a very perfect and beautiful glass cornea^ and he will test it, if a 
suitable case presents itself. 

Dr. DuRKEE considered the operation described in the communication from 
Dr. Burnett as a specimen of very ingenious ophthalmic surgery. He had, 
however, great doubts as to its practicability on the human subject. The 
operation might possihli/ be successful, considered merely in a surgical point 
of view, and yet be an entirely useless one to the patient. It seemed to him 
that the laws of optics, in regard to the refraction of the rays of light in its 
passage through the cornea, the aqueous humour, the crystalline lens, and the 
vitreous humour, each having different powers of refraction, and each having 
a different density and different shape from the other, would be disturbed in 
a manner that would prevent the formation of a distinct image of objects on 
the retina. Dr. D. was not, therefore, inclined to coincide with the opinion of 
Dr. Burnett, as expressed in the closing sentence of his manuscript. The 
rays of light, it seems, are to be admitted through a very minute aperture. 
This aperture will act in the same way as a small perforation does through a 
card. And how is this? The rays must cross each other in their transit 
through this opening. They must, consequently, enter the aqueous humour 
greatly divergent; and thus the very first step in the series of refractions is 
reversed. How is it possible for these divergent rays to be changed in their 
direction, so as to pass through the crystalline lens in the normal manner? 
The rays of light, as they pass from the cornea through the aqueous humour 
in the sound eye, are rendered more convergent than while passing through 
the cornea. This increase in their convergence through the aqueous fluid is 
necessary in order that the rays may reach the lens in a proper manner. But 
Dr. Durkee could not understand how it was possible for this order of refrac- 
tions to be secured after the surgical operation in question had been performed. 
For the rays traverse no cornea, and the shape of the aqueous humour must 
be altered, and the light be confused. The different chambers may be illumin- 
ated, to a greater or less degree, through the small opening in the glass stud; 
but that a distinct image could be spread out upon the expanded surface of 
the retina, appeared to him a matter of great doubt. In the account furnished 
by Dr. Burnett, it is not stated that the animals operated upon were enabled to 
see. Ophthalmic surgery has accomplished wonders, it is true; but in this 
instance the principles of optics will be so much disturbed that the intended 
result of the operation will almost certainly be defeated. Such, at least, is 
Dr. D.'s opinion. 

Dr. D. thought the chances for distinct vision would be greater, if the 
glass were solid instead of being tubular. The glass would then be a substi- 
tute for the portion of cornea that had been removed by the operation. It 
would present an unchangeable uniformity for the admission and transit of 
the rays of light. But it is scarcely to be supposed that the aqueous fluid 
occupying the tube — and there being no way for confining this fluid, or for 
regulating its shape, or for preventing the constant movement of its particles — 
can possibly preserve any fixed form. It will be in continual agitation except 
•during sleep. If we attempt to look at an object in water while the water is 
in a state of agitation, we find that vision is disturbed ; we see the object in 
broken fragments and assuming all manner of distortions ; and in the case 
before us, the aqueous humour will be constantly oozing out through the 
opening in the glass, and irrigating the surface of the eye. How is it pos- 
sible, under such circumstances, for the rays of light to be transmitted towards 
the crystalline lens in the proper, regular order, without which there can be 



1854.] Morland, Extracts from Soc. for Med. Improvement. 99 



no correct vision ? The practicability of the operation, whether considered as 
a matter of surgery, or in its relations to the principles of optics, remains to 
be proved. Dr. J), demonstrated his ideas upon this subject by drawings 
upon a blackboard. 

Dr. Bethune exhibited to the Society specimens of the glass cornea, which 
with great trouble he had procured. The same workman will doubtless now 
be able to furnish others, after this model, with greater ease, and promptly, 
should there be found a use for them. 

Dr. Williams made the following remarks relative to the operation : — 

The Union Medicale, of Paris, in some of its numbers for January, 1854, 
alludes to the operation proposed by Dr. Nussbaum. The proposition is 
condemned by the editor in strong terms, and characterized as " worthy of a 
German brain." A subsequent number contains two letters — one from a 
Grerman physician, who repels the imputation against his countrymen, as 
entirely too sweeping, but coincides with the editor in his estimate of the 
value of the experiments made upon animals, and deprecates their repetition 
upon the human eye — the other letter is from Dr. Deval, of Paris, of some 
authority in ophthalmic surgery ; and contains proof that the plan proposed 
by Dr. Nussbaum has in it nothing of novelty, as not only had the insertion 
of an artificial cornea been proposed and practised upon animals, but the arti- 
ficial substitute had been made of similar form to that now advocated. Dr. 
Nussbaum, he shows, has mejely revived an operative procedure which had 
become obsolete. He refers to the discussions to which the subject had given 
rise in Germany, and states that the experiments on the human eye have 
been condemned by Dr. Pauli, of Landau, and other distinguished authorities; 
and further, that Dr. Nussbaum had recently performed his operation on a 
patient, with no other result than a total failure. 

[Malgaigne writes as follows in his 31edediie Operatoire, p. 406 (4th ed. 
1843) : " Pellier was the first who proposed excision of the natural cornea, 
and the fitting of a glass cornea within its circumference. This extraordinary 
(bizarre) idea has never yet been applied to the human eye, and doubtless 
never will; it has not even been tried upon animals." It has only been 
shown that the glass stud can be inserted and worn in the eye of an animal, 
and not that the animal could see therewith. The eye of such an animal, 
previous to the operation, is supposed to be in a healthy state ; the human 
eye must be, or have been, in a diseased and abnormal state, to require any 
such attempt at giving a new cornea; — would not this fact influence the 
result ? If even it be proved that the animals thus treated can see, no such 
success could tlierefove be predicated for man. — Secretary.] 

^ft.scm of the Lungs witJiout previous Sj/m-ptoms or any evident Cause. — Dr. 
Coale reported the case of A. G., 93t. 26, a carpenter, who considered him- 
self in perfect health until Wednesday evening, February 8, when he was taken 
with a violent " cramp colic," referable to the right iliac or hypochondriac 
region. His physician partially relieved him, by opening his bowels. Costive- 
ness again occurred, and the pain returned, so that on Saturday night Dr. C. 
was sent for in consequence of dissatisfaction with the physician in attendance. 
Refusing to visit at that time. Dr. C. did not see him till Tuesday, 14th. Found 
great tenderness midway between right costal cartilages and crest of ilium of 
same side. Bowels costive. Tongue furred. Pulse 80. Purged gently and 
blistered the spot, which perfectly relieved symptoms, so that on Wednesday, 
22d, eight days after. Dr. C. paid him the last visit he deemed necessary for 
a week. On the next Monday, February 27, he came to report himself at Dr. 



100 Morland, Extracts from Soc. for Med. Improvement. [July 



C/s office. He was costive, but otherwise well, and some aperient pills were 
ordered. On Saturday, March 4, Dr. G. was again sent for. The patient had 
been improving in general health and strength until Tuesday afternoon, when 
he was taken with a sudden tickling in the throat, and on coughing a gush of 
pus took place from his mouth, amounting in the course of two or three hours, 
as the family said, to the better part of a pint, half of the quantity coming at 
the first gush. When Dr. C. saw him he was sitting up, and very comfort- 
able while in that position. Pulse 80. No unusual heat of skin. No pain. 
Cough at times, with expectoration of a half mouthful of fetid pus. Lying 
down instantly brought on cough. He took this position at Dr. C.'s request, 
and was soon compelled to rise, when he covered the bottom of a handbasin 
with pus immediately, it coming up very freely; R. Elix. opii et vin. ipecac, 
as occasion required. Being deprived of the use of his left hand, Dr. C. could 
not examine the chest, but this was done the next day very thoroughly by 
Dr. Oliver. Dulness all around on the right side from outer edge of car- 
tilages to sixth rib. There were sonorous, sibilant, and gurgling rales on that 
side, over the dull part; and some of these continued up to the clavicle. Under 
these circumstances, the previous good health and well being for the ten days 
before the gush took place ; the sudden gush of pure pus ; the dulness of the 
inner part of the chest ; the mixed rales ; we could not doubt the existence 
of an abscess of the lungs. No particular treatment was used, as none seemed 
necessary. Nature had a certain piece of work to do, and seemed fully able to 
do it. Dr. C. visited him until Monday, March 13th, the general symptoms 
not amounting to anything worthy of note during this period, except the neces- 
sity of sleeping in his chair, which apparently brought on a temporary swell- 
ing of his legs. Wednesday, 15th, he went out. Thursday, 16th, he called 
at Dr. C.'s house ; no excitement of pulse, good appetite and digestion ; slept 
well; coughed very little; expectoration very little. Saturday, 18th, again 
reported himself as doing very well. Saturday, 25th, very well in all general 
and apparent circumstances. Dulness as high as eighth rib. A feeble respi- 
ratory sound before this. No rales. Face of a good healthy colour. Strength 
good. In short, no marks whatever of the invalid about him^ except the phy- 
sical signs just mentioned. 

To conclude : 1. The case was evidently one of pulmonary abscess. 2. It 
came on without any previous ascertainable cause, either external or in the 
system of the patient. 3. It was not preceded by any appreciable symptoms. 
4. It got well without any treatment being necessary. 

Dr. Coale added that these peculiarities, so far as he had been able to 
ascertain, make it a unique case, particularly the first and second points. 

External JJ&e of the Tincture of Aconite. Three Cases. — Dr. Storer ob- 
served that, after the discussion which took place a few meetings since upon 
the effect of aconite, he had determined to present to the Society several cases 
in which he had administered it at the Hospital. He had, however, been 
unable to analyze the cases, and would, therefore, offer but these three cases 
. of about sixteen which he had treated ; and they among the most favourable. 

M. E., ast. 45, entered Hospital, June 4, 1850; — six months previous to 
entrance was attacked with pain in lumbar region and left lower extremity, 
most severe in former, confining him to his bed for two months. After the 
application of a blister to back, two months ago, pain had nearly disappeared 
and has been very slight since, but that in leg at once increased, the limb 
being always cold and at times numb, with some diminution of sensibility; 
though lameness appears to have been caused by pain rather than by loss of 



1854.] Morland, Extracts from Soc. for Med. Improvement. 101 



muscular power; walks with a cane, but with considerable difficulty on account 
of pain. Some tenderness on pressure along outside of left thigh as well as 
in gluteal region. 

^th. Dry cupping about region of sciatic nerve on left side. 

9^/i. Acupuncture to left hip succeeded, and the following liniment twice 
daily to be applied to hip : R. Olei olivse ^iss; acidi. sulph. 5iss; olei tere- 
binth, gss. M. 

12#7i. Cantliaridal Collodion applied to left hip. 

13//i. Much relieved since blistering. 

24//i. Pain about the same of late, though he walks much better than on 
entrance. Reapply blister. Pain about the same. 

July 1. I took charge of the Hospital and found patient walking not only 
with a cane, but with great difficulty, with two — or rather crutches, although 
I find no record making mention of this fact. 

IcL Complaining of pain and numbness in thigh. Applied to thigh tinct. 
aconiti sat. 5jj twice daily. StZ. Less pain. 

4:th. Continues to receive relief after each application of aconite. 

bth. Soreness in knee diminished. 

^tli. Knee continues relieved. Still has a dull pain in hip. 

\2th. Still improving. Apply aconite three times daily. 

\^th. Had a shooting pain last night, not only through hip, but down leg 
to ankle. Returned this morning. Relieved by application of aconite. 

Last evening and this morning pain returned in hip extending through 
whole length of limb to ankles. Aconite increased to 5ii- 

21st. Pain returned in night of a character similar to that of the previous 
day, and continued for about two hours ; relieved, he says, by application of 
the remedy. 

23(i. Paroxysm of pain through leg last night which continued about half 
an hour ; relieved by application. No return of pain this morning. 
Z^tli. Doing well. 

August 1. Complains of no pain in thigh; reports "as well as ever.^' Dis- 
charged well. 

June 30, 1853. J. H. E., aged 40, works in a clothes-drying machine. 
About a year ago was attacked with pain and numbness and prickly sensation 
in soles of feet, which afterwards extended to hands. At times, at intervals 
of a month, had bilious attacks with vomiting, lasting a day or two. Gave up 
work two months ago. A month since was attacked with sudden pain in 
shoulder running down to the heart. Was delirious with pain in the first 
part of attack. Unable to sleep without an anodyne. Has lost flesh very 
rapidly. Has not walked for a month. Has no power over lower extremities 
below the knees, but sitting in a chair can raise his feet upon the bed by the 
flexors of the thigh. Has not lost sensation in feet, but experiences great 
pain in ankles and soles of feet. Arms powerless below elbows ; sensation 
somewhat impaired, though a "prickly pain,^^ as he expresses it, is produced 
by rubbing their posterior surface. P. M. Complains of very acute pain in 
feet upon pressure. Constantly groaning. Let him have of R. Morphiae. 
sulphatis gr. ii; aquae ; a drachm, and repeat every hour till relief. Apply 
to soles of feet — R. Tinct. aconiti saturat. 5j- 

July 1. Took morphia twice. Aconite was applied once. Yery soon expe- 
rienced some relief. Complains now of no pain. Speaks only of a sense of 
numbness in upper and lower extremities. Let him be rubbed night and 
morning with — R. Tinct. capsici. ; tinct. cantharid. fab. aa 5j. M. Repeat 
morphia if necessary ; if pain return in feet, reapply aconite. 



102 Morland, Extracts from Soc. for Med. Improvement. 



2(^. Thinks he has more use of hands. Reports himself as much more 
comfortable. 

3d Slight return of uneasiness yesterday, P. M., in right foot. Aconite 
was applied, and he soon experienced some relief. 

4ith. Has suffered since yesterday more from increased numbness in hands 
and feet, and burning sensation in calves of legs. By misunderstanding of 
nurse, aconite was not applied. Bowels constipated. R. Pil. aloes et colo- 
cynthid. gr. x. 

bth. Ileturn of inconvenience in feet yesterday afternoon ; not, however, 
severe, and readily relieved by aconite. Had a comfortable night from mor- 
phia. Bowels open. 

8(!/i. Since 5th, has been quite comfortable ; does not feel as well to-day ; 
has suffered uo severe pain, but still complains of uneasiness in feet and hands. 
Omit the wash now used on arms and legs, and substitute tinct. aconit. sat. 

V2th. Had yesterday a salt-water hath. Doing well. 

Wth. No return of suffering in feet. Thinks he has some motion in them. 
Has omitted morphia the last three nights. 

\bth. Decided improvement in motion of hand, but makes no complaint. 

\Qth. Still improving ; has no pain. Substitute for aconite, salt-water.^ 
warm, night and morning. 

20^A. Thinks limbs are less flexible, let them be bathed mornino; and night 
with tinct. sapon. et opii. 

'I'ld. Uneasiness in right foot not diminished for last three days. Apply 
unguent, veratrise gr. viii. to the drachm. 

*lbth. Sensation in hands now nearly natural ; motions in all directions; 
complains only of weakness. Motions of feet constantly improving. 

I. B., set. 38, engineer, entered Hospital October 12, 1853. Some four 
months since, while at the West, after taking cold, was attacked with violent 
pain, and heat and swelling in feet, especially the left. Had about the same 
time an attack of bilious diarrhoea, and was obliged to keep his bed for two 
months. About two months since came from Ohio, and now makes no com- 
plaint but of pain in feet, which are somewhat swollen ; the cuticle is peeling 
off as if bruised. Feet not so tender but that he can walk about. Says he 
has often excruciating pain by night, keeping him awake; has been in the 
habit of taking morphia every night to procure sleep. Pain is constant in top 
of foot, and at times also shoots up his leg and down to the toe. Apply to 
feet, tinct. aconit. sat. 5j ter die; fluid extract of valerian Jj? at bedtime. 

1-ith. Had a disturbed night from pain ; now bears pressure much better 
than yesterday. 

Ibth. Suffering in feet diminishing. 

19^/i. Free from pain since yesterday's visit. 

20^/i. Had shooting pains at intervals during night, which he attributes to 
omission of morphia at bedtime. 

21s^. Says for last three or four days has been relieved during the day, but 
pains return at night, continuing till morning. Let him have sulph'. quinia, 
. grs. ii ter die. 

23c/. Continues to improve. 

26</i. Had a very comfortable night, better than any since entrance ; took 
no morphia. 

3U<. Complains of sensation of soreness rather than pain in right foot. 
Substitute for tinct. aconite, tinct. saponis et opii 3j- 

Noo. 4. Thinks he has improved rather less since omitting aconite. Apply 
olei tereb., tinct. sapon. et opii, tinct. aconit., equal parts. 



1854.] Morland^ Extracts from Soc. for 3Ied. Improvement. 103 



Qtli. Less paia than any morning since entrance. 

19;'/t. Able to walk a mile or more without difficulty; has no continuous 
pain, but occasionally it darts along ball of foot and to great toe — not up the 
leg. Bears pressure everywhere without pain, but a slight touch to toe 
causes a feeling of tenderness. General health perfect. 

21s^. Discharged well. 

Dr. Putnam suggested that instead of a speciiBc quantity being ordered to 
be applied, it seemed a better way to direct the tincture to be rubbed in until 
tingling was produced. 

Dr. Storer thought that too large a quantity might be absorbed in this 
way. 

Dr. Putnam had never seen persistent ill effects from its external use ; 
but he had heard of an instance of permanent facial paralysis following its 
employment in the way mentioned by Dr. Storer for neuralgia. It sometimes 
produces distressing temporary effects. Dr. P. added, byway of sequel to a 
case formerly reported by him, in which a drachm of the saturated tincture 
had been swallowed by mistake (see No. of this Journal for July, 1853, p. 69), 
that the patient, after recovery, found herself completely and permanently 
cured of the neuralgia, for which the external use of the remedy had been 
ordered. 

Dr. Bethune thought that the principal difficulty in the employment of 
the tincture of aconite was, that the part became, in time, insensible to its 
effects. He mentioned cases in which this occurred. 

Protrusion of the Nictitatmg Memhrane in a Horse, and Tumour connected 
therewith. — Dr. Bethune was consulted a few weeks since by a gentleman who 
owned a valuable horse, in reference to a protrusion which had occurred between 
the lids of one of his eyes. On examination, it was found to be a fold of the 
nictitating membrane. It had existed above three weeks, and the owner thought 
was connected with an attack of the distemper, which appeared severely last 
spring, and from the effects of which the horse had never entirely recovered. 
The eyes, he thought, had been inclined to run from that time. After wait- 
ing a week longer, as the disease appeared to increase, it was determined to 
remove it. Assisted by Dr. Wood, the veterinary surgeon of this city, the 
horse was cast and secured. A further examination now showed a tumour 
beneath the conjunctiva of the lid, by which the nictitating membrane was 
pushed out from between the lids. This was removed, and was found to be 
of the size of a walnut, elongated and irregularly rounded. Its external ap- 
pearance and the microscope both proved its fibro-cellular and non-malignant 
character. A portion of the exposed haw was removed with it, and a week 
or ten days after, the animal appeared quite well. As far as he could learn, 
tumours in this position in horses are quite rare. In this case, it probably 
had no connection with the previous catarrhal affection. 

Poisoning hy Prussic Acid. — Dr. H. Gr. Clark reported a case of suicide 
by prussic acid. A German, after playing whist and drinking beer at a 
public house, went to bed. Soon afterwards he was heard groaning, and, the 
room being entered, he was found insensible, and died in fifteen minutes, 
and in three quarters of an hour after entering his room. The organs of the 
body were all found to be perfectly healthy, except that the brain was slightly 
congested. No odour of prussic acid was perceptible in the cavities, though 
carefully sought for. The stomach was given to Dr. Bacon for examination. 

Dr. Bacon stated that the stomach, which had not been opened at the 



104 Morland, Extracts from Soc. for Med. Improvement. [July 



autopsy, was examined on the third day after the patient's decease. Its 
exterior presented nothing remarkable, except that the course of the large 
venous trunks, especially about the cardiac end, were marked by dark blue 
lines; on opening it, the mucous membrane, at the greater curvature, was 
found somewhat congested, and of a dark red colour, which passed gradually 
into a light pink at the pyloric end. The contents were about six ounces of a 
gray, pultaceous mass, with fat and fragments of food; they were acid to test- 
paper, and had a peculiar acid odour, which did not suggest that of prussic 
acid, though, after the detection of this poison, a distant resemblance was re- 
cognized in the odour. 

Prussic acid was discovered by the appropriate tests, applied to the vapour 
evolved from the contents without heat. A portion of the contents distilled 
by a water-bath, yielded a clear fluid which had a decided odour of prussic acid, 
mixed with that of butyric acid, and in which prussic acid was readily detect- 
ed. Perhaps a drachm of the medicinal prussic acid was present in the con- 
tents of the stomach; how large a quantity had been taken could not be ascer- 
tained. No other poison was found. « 

Adherent Placenta. — Case reported by Dr. Storer. Dr. S. was called, on 
the evening of the 27th ult., to attend Mrs. S. in labour with her first child. 
Patient aged 21 years; very stout and healthy, weighing 180 pounds. After 
suffering to a greater or less extent for forty-eight hours, she was delivered of 
a still child. The second stage of labour continued only about a couple of 
hours. After waiting some time for the expulsion of the placenta. Dr. S. 
passed his hand into the uterus, and found the after-birth firmly adherent, 
throughout its entire extent to the parietes of the organ. He made a slight 
effort to remove it, but found it impracticable. At the expiration of an hour 
he determined to attempt its extraction, and, expecting much hemorrhage to 
supervene, and that a considerable length of time would necessarily be em- 
ployed in the process of detachment — if, indeed, it could be done — he admi- 
nistered half of a drachm of ergot. After it had been taken, the remembrance 
of two similar cases which had occurred in his practice several years since, 
both of which had terminated fatally, the one in opisthotonos, and the other 
in inflammation and disorganization of the fundus of uterus,* determined him 
to do nothing further without assistance. He accordingly -sent for Dr. Chan- 
ning, who made a very careful examination, and ascertained that a very slight 
detachment of the placenta, of perhaps an inch in extent, had taken place 
towards the anterior portion of the fundus, produced undoubtedly by the 
powerful uterine contraction caused by the ergot. As great suffering was 
produced by the most careful manipulations. Dr. C. administered the sulphuric 
ether by inhalation, while Dr. S. reattempted the extraction. With much 
difficulty he was enabled, by commencing at the detached portion, gradually 
to separate the placenta by peeling it, or rather tearing it, from the uterus; 
and eventually, after exertion continued for about twenty minutes, almost the 
entire portion was removed; small detached particles being alone left. The 
uterine contractions were so severe that but little hemorrhage ensued, and she 
was left a couple of hours after the birth of her child, comfortable. For several 
days she was watched with unusual interest, but not an untoward symptom 
has occurred since the night of her accouchement, a month since. 

April 10. Compressed Aspect and Condition of the Lung after Bron- 
chitis. — Dr. J. B. S. Jackson referred to an instance of this appearance 

* Both of these cases were reported to the Society at the time of their occurrence. 



1S54.] Morland, Extracts from Soc. for Med. Improvemenf. 105 



noticed by him in the lower lobe of the left lung; a compressed and flaccid 
condition, as if the organ had been beneath pleuritic effusion, of which latter 
there were no traces. Dr. J. remarked that Dr. James Jackson had inquired 
of him, respecting this case, whether the bronchia were examined, referring 
to the views of Dr. G-airdner (of Edinburgh), relative to this state of the 
lung, and that it is often caused by the exclusion of the air from the vesicles, 
and their collapse consequent upon the blocking up of the bronchial tubes bj 
tough and adhesive mucus. Dr. J; said that this patient had been subject to 
bronchitis; he had not, however, observed any mucus obstructing the air-tubes, 
except one, on section of which there was some noticed. The upper lobe of 
the left lung had become hypertrophied, to supply the lack of action conse- 
quent on the compressed condition of the lower lobe; the upper lobe was esti- 
mated by Dr. J. to be one-half larger than its ordinary size. He referred, in 
this connection, to an instance of entire destruction of the left lung in infancy, 
and in the subject of which the right lung became nearly as large as both 
usually are. In the case which forms the basis of these remarks, there was 
emphysema of the anterior poition of the lungs, and also some pneumonia 
(Dr. Grairdner mentions the occurrence of emphysema in his cases); in the 
middle of the right lung there were appearances as if of tubercular disease, 
but, in fact, this was discovered not to be the case; there were but few tuber- 
cles in any portion of the lungs. 

Dr. BoTVDiTCH remarked that often, lately, when about to puncture the 
chest in cases apparently offerihg most of the signs — and particularly the flat- 
ness on percussion — of pleuritic effusion, he had thought of Dr. Gairdner's 
opinions, having found, in many instances, no fluid upon effecting para- 
centesis. 

Dr. Bethune asked if some dulness be not often caused, m pleuritic cases, 
by the existence of false membrane? 

Dr. BoWDiTCH replied affirmatively, but added that this cause would not 
account for all the dulness on percussion which is sometimes found. 

Dr. MiNOT inquired if mensuration of the chest would not generally show 
a relative difference in the volume and in the shape of its two sides, in cases 
of pleuritic effusion ? 

Dr. BowDiTCH : X ot necessarily. 

Dr. C. E. Ware referred to instances of bronchial respiration existing in 
pleuritic cases, and asked if it does not always, or, at least, most frequently 
exist ? 

Dr. BoTVDiTCH thought it often concomitant. He remarked that it is not 
always the length of time the effusion has existed, that is the cause of the 
compressed condition of the lung, for he had operated on a case in which a 
pleuritic effusion had existed several months, and yet the luns expanded 
freely and very soon; whereas, in another case, of a few weeks' duration, the 
condensed condition of the lung was manifest for months after the patient 
was comparatively well. 

Empyema. — Dr. C. E. Ware reported the case of a man, 56 years of 
age, of a strong and vigorous frame, who had had a slight cough, and 
occasional pain, at first in his right side, afterwards in his left, for about 
three weeks previous to the time when Dr. Ware was called to him, Feb. 22. 
He had had his usual appetite, and attended to his usual duties. In the 
afternoon of Feb. 22, he was attacked with a much more violent pain than he 
had experienced before, in his left side, accompanied by considerable dyspncea, 
but by no chill, or any marked febrile symptoms. The next morning, there 
was dulness on percussion at the base of the left lung, joined with deficient 



lOG Morland, Extracts from Soc. for Med. Improvement. [July 



respiration, a bronchial expiration, and resonance of the voice. The next morn- 
ing, Feb. 23, there was, as high as the angle of the scapula, on the left back, 
bronchophony, and bronchial respiration, with a crepitus around it. Cough, 
and expectoration of a viscid, tenacious, transparent mucus, in considerable 
quantity, without colour, and without blood. Pulse 96. On the 24th, the 
bronchial sounds were less pure, and were mixed with fine crepitous rales. 
On the 25th, the bronchial respiration had entirely disappeared, and subcrepi- 
tous rales were heard over the whole left back up to the spine of the scapula. 
The dyspnoea and cough had very much subsided. The pulse 96. On the 
28th, the pulse was 72, and he was in all respects convalescent; there was 
still some dulness on percussion, and subcrepitous rales in left back. 

March 2d. There being no aggravation or return of any other symptoms, 
Dr. Ware discovered an obscure and distant bronchial expiration at the angle 
of the left scapula. On the 4th, pulse and tongue natural, good appetite, 
natural sleep. At the angle of the left scapula, bronchial expiration without 
rales, bronchophony, and dull percussion. On the 5th, he was on his bed, 
with pulse 108. The 7th, perfectly flat on percussion over the left back, with 
a clear oegophony; slight cough, with no expectoration. To the 10th, the 
effusion continued to increase. There was more cough and dyspnoea. The 
pulse was 120. The expectoration was viscid transparent mucus, very small 
in quantity. Through the day, the dyspnoea continued to increase very ra- 
pidly until 9 o'clock P.M., when the patient was sitting up, unable to lie 
down; skin cold and damp; pulse 128, very feeble; respiration gasping; coun- 
tenance sunken ; voice whispering. On percussion, there was entire flatness 
over whole left chest. The heart was pushed entirely to the right of the 
median line. 

At 9 o'clock, the left chest was tapped a little below and outside of the angle 
of the scapula, and with a suction-pump two quarts of thin and very fetid pus 
were drawn off. At half-past 10, about three quarters of an hour after the 
operation, the expression and colour of the countenance had become natural; 
the skin warm and dry ; the respiration easy, in a reclining position. There 
was a good resonance on percussion over the whole chest, together with re- 
spiratory sound and crepitus; the pulse 120. At 5 P. M. of the 11th, the 
pulse was 112, full. There was a subcrepitous rale over the whole left back, 
and the sounds of the heart had returned to their normal location. There 
was not now, nor had there been at any time, the slightest fetor of the breath. 
On the 12th, the general condition was the same; the pulse 108. When 
lying on his back, under the left clavicle, for about two inches down, there 
was very strong tympanitic resonance on percussion, with loud, copious gurg- 
ling; but no resonance, of voice, nor pectoriloquy. Immediately, on sitting up, 
there was dulness on percussion, and subcrepitous rales over the same space. 
From this time his pulse continued to increase in frequency, and it was evident 
that the fluid was again accumulating. His general symptoms were all ag- 
gravated, and he died very suddenly, at 2 A. M. on the 16th. 

Autopsy. — Very little emaciation. On puncturing the pleura, there was an 
escape of gas. On removing the sternum, there was discovered, on the left 
side, a cavity, at' the upper part, about half full of thin fetid pus, separated, 
by a septum of adherent lung, from another cavity, at the base, of about the 
same size, containing about the same quantity of pus — about a quart in the 
whole. These cavities being in the pleura, the lung, at the apex and at the 
base, was compressed, and both cavities were lined by a thick coating of lymph. 
Air forced into the trachea expanded the lung, but showed no opening into 
the pleural cavity There was no sign anywhere of gangrene. The lung, 



1854.] 



Morland^ Extracts from Soc. for Med. Improvement. 



107 



although condensed by compression, appeared healthy and firm. It was rather 
dark coloured at the surface, but less so at the root, where it was less com- 
pressed. At one point, near the mediastinum, there was a purulent deposit 
in the substance of the lung, about a teaspoonful in amount. Jn the medias- 
tinal cellular tissue, there was extensive purulent infiltration. There was no 
purulent deposit discovered in any other organs of the body. The right lung 
and pleura were perfectly healthy. There was no trace of tubercle in either 
lung. There was a slight eflfusion into the pericardium, and the surface of 
the heart and pericardium were coated with a very rough deposit of lymph. 
Nothing anormal in the heart. Nothing was discovered after death to ex- 
plain the extreme fetor of the fluid in the pleural cavity. There was no com- 
munication with the air; there was no gangrene. There were no tubercles. 
The effusion was not of long duration. It supervened very gradually upon 
the subsiding pneumonia. The pneumonia was not attended by very active 
symptoms, and was short in its duration, yielding promptly to leeching and 
simple opium treatment. The sudden death was probably due to the com- 
plication of pericarditis with the pleurisy. Dr. Ware thought that this must 
have occurred after the operation. Had it existed earlier, he thought, that 
after the chest was evacuated, and before it filled again, he should have dis- 
covered it by the physical signs in his repeated examinations of that region. 
The occurrence of gurgling with tympanitic percussion, at the upper part of 
the left chest, was an interesting physical sign to notice. No one who heard 
it would hesitate a moment to'say, unless he was cautioned by the history of 
the case, that there was a large cavity in the lung. The lung was perfectly 
healthy, except for compression. The sounds were owing to the lung expand- 
ing in a cavity containing air and fluid. 

The operation gave very great and immediate relief. Indeed, death was 
imminent, and it saved the patient's life for the time. He would have been 
operated upon again, had he lived another day. It was obvious, however, 
from the appearances at the autopsy, that the operation would have been un- 
successful and useless. The chest had been divided by the adhesion of the 
lung since the first operation, so as to form two cavities, each containing a large 
quantity of fluid. The lung was adherent just where there was every indica- 
tion externally for the performance of the operation. It was so compressed 
by the fluid where it was in contact with the walls of the chest, that it returned 
no more sound than when there was fluid. The lung would, therefore, in all 
probability, have been perforated, and not the cavity. 

Dr. Bethune asked if it were possible that air could have entered the chest, 
when the latter was tapped for the purpose of drawing off the contained fluid? 

Dr. Ware thought not; he referred the production of gas within the chest 
to decomposition of the pus. 

Dr. BoWDiTCH was quite certain that no air could have gained admission 
at the operation; he had taken sufficient precautions to prevent such an acci- 
dent. 

Dr. J. B. S. Jackson, referring to the adhering band of false membrane, 
which was stated to have divided the thoracic cavity into two parts, said that 
it is not uncommon to find such a structure, and also a pint or two of foul 
matter helow the band, while the membranes are in a better condition above, 
and sometimes quite smooth and polished. 

Dr. BowDiTCH thought that it was quite rare to find so very fetid pus in the 
chest. He regretted that he had not injected iodine and iodide of potassium 
into the thoracic cavity. He thinks that, in similar circumstances, he should 
decidedly use this means. He agreed with Dr. Ware in his remarks that a 
second operation would have been of no service to the patient. 



108 Morland, Extracts from Soc. for Med. Improvement. [July 



Premature Birth. — Dr. Storer had put a woman to bed, since the last 
meeting of the Society, with a premature child; she lacked two weeks of being 
six months pregnant; in other words, she was five and a half months advanced. 
The child weighed just one pound; measured 12 -J inches, entire length; 
inches to the umbilicus; 8 J inches across the occiput, and lived fifteen hours. 

Erysipelas after Vaccination. — The following remarks were elicited by the 
report of a case of the above nature, at the meeting of the Society, holden 
March 27 ; and which was related by Dr. Stoher, in reply to a query by Dr. 
J. M. Warren, whether any such cases had been observed, he having lately 
heard of a case following re vaccination. 

Dr. Storer' s report is that he lately saw a child in whom erysipelas was 
developed after vaccination. The matter introduced was taken from a per- 
fectly healthy child; the day after vaccination, erysipelas appeared about the 
punctures and gradually extended over the whole arm, then attacked the other 
arm, passed down, covering the entire back, and disappeared after extending 
to the ankles. The child was about nine months old, was kept constantly at 
the breast, and at the expiration of ten weeks was entirely well. Dr. S. had 
applied the tincture of iodine with benefit, though without arresting the dis- 
ease, as he has usually been able to do with this remedy. 

Dr. DuRKEE inquired of Dr. Storer, if, in the above case, the application 
of the tincture of iodine prevented the formation of vesicles upon the integu- 
ment ? 

Dr. Storer replied that there were no vesicles formed, and he spoke highly 
in favour of the tincture of iodine as a local application in erysipelas; in every 
case, it almost instantly arrests the progress of the disease, and he had not 
found, usually, that the latter extended beyond the portion of the skin covered 
by the application. 

Dr. D. remarked, that for several years he had used iodine as a topical 
remedy in erysipelas. He considered the simple tincture inferior to the ethe- 
real preparation. He had used the latter, having a strength of thirty grains 
to the ounce, and applied it freely to the affected surface. It did not produce 
as much pain as the ordinary tincture. The ether evaporates instantly, and, 
if the patient complains of the severity of the pain, the application of pure 
ether would dilute the iodine at once, and thus diminish the suffering. He 
knew of no other topical remedy that would prevent the formation of the 
phlyctense, and arrest the erysipelatous inflammation at this stage ; but the 
iodine will do this if liberally applied, so as to turn the skin nearly black. 
Merely to produce a brown discoloration is not sufiicient. A physician in full 
practice in a neighbouring town recently stated to Dr. Durkee, that he had 
used the ethereal tincture in quite a number of cases of erysipelas, and he 
regarded it as decidedly preferable to any other outward application. 

Dr. D. considers the vascular portion of the skin to be the primary seat 
of the disease in question. In simple erysipelas, the superficial capillaries 
alone are implicated; and, during the first or congestive stage of the inflam- 
mation, the iodine can be applied advantageously, and will usually arrest its 
• further progress. But there is quite a difierent state of things in the second 
variety ; that is, in phlegmonous erysipelas. Here the morbid action, which 
commenced in the superficial vessels, extends to the deeper vascular tissue of 
the chorion and the subjacent cellular membrane. And the inflammation, 
instead of producing a serous effusion in the form of vesicles upon the sur- 
face, yields a purulent matter, which is infiltrated into the subcutaneous cell- 
ular and muscular tissues. 



1854.] Morland, Extracts from Soc. for Med. Improvement. 109 

Dr. Putnam asked for results of the application of tincture of iodine in the 
erysipelas followiog surgical operations and accidents. 

Dr. Cabot had found it not satisfactory when applied upon surfaces, but 
serviceable when thrown into sinuses; traumatic erysipelas, he remarked, 
affects tissues more deeply than does that of the surface; hence, local applica- 
tions are likely to be less effectual. In a case of erysipelas supervening upon 
ecthyma, in an old woman, Dr. C. had found the tincture of iodine ineffectual 
in arresting the progress of the disease. 

Dr. C. E. Ware had never witnessed any efficient curative action from the 
local application of tincture of iodine in erysipelas. 

Dr. DuRKEE insisted again, and strongly, upon the rery free use it was neces- 
sary to make of the tincture ; he often pours twenty or thirty drops upon the 
affected part, spreading it instantly with a camel-hair pencil. 

Dr. Parkman asked if any constitutional treatment was tried in Dr. Storer's 
case ? 

Dr. Storer said there was none ; the patient being so young, it was not 
judged advisable to attempt any, even had it been deemed practicable.* 

Dr. Parkman thought that many cases of erysipelas were referable to con- 
stitutional causes, and should be treated accordingly. 

Dr. Strong believed that depression of the vital powers and debilitating 
influences exercised upon the system, together with depravation of the blood, 
were circumstances preparativejind quasi causative of erysipelas in nearly, or 
quite, all cases ; consequently, the manifestation of erysipelas is a measure, as 
it were, of the amount of derangement or depravation of the system. 

The connection of erysipelas ^iih. puerperal peritonitis being alluded to; 

Dr. C. E. Ware said, that although the terrible consequences of the acci- 
dent when it did occur, made it the duty of every physician to be very guarded 
how he passed from cases of erysipelas to cases of midwifery; yet that the 
accident was a very rare one, and, probably, liable to occur only under some 
peculiar circumstances, or only from certain forms of erysipelas. It frequently 
happens that for intervals of months at a time erysipelas is epidemic amongst 
us, and no physician, in large j)ractice, is, during that interval, without more 
or less cases of erysipelas upon his hands. He never heard of any physician 
abandoning his practice of midwifery on this account. And he had heard of 
only one or two instances within the last fifteen years, known to the rest of 
the profession, in which physicians were supposed to have communicated the 
disease. 

Dr. Putnam remarked, that he had been much surprised to find Dr. Hodge, 
in a recent lecture, scouting the veri/ idea of any such a connection. 

[At a recent meeting of the "3Jedico-Chirurgical Society,^^ of Richmond, a 
discussion upon the effect of local applications in erysip)elas elicited various 
opinions. Among others. Dr. Otis, one of the editors of the Virginia 
Medical and Surgical Journal (see number for April, 1854), "expressed his' 
astonishment at the importance attributed to the local treatment of erysipelas 
by the physicians who had spoken. None of the local applications (among 
which he refers to tincture of iodine'), he maintains, are supported by any pre- 
cise evidence derived from any considerable number of cases in which they 
diminished the duration of the disease; most of them have the disadvantage of 
concealing the seat of the disease. It would appear that no one has tried the 

* [M. Grisolle, who is opposed to all external medication in erysipelas, remarks, 
also, that none of the applications made use of, even the actual cauteiy, have ever 
availed in the erysipelas in the neicly-born infant. — He does not mention tincture of 
iodine among the other applications. — Pathologic Interne, vol. i. p. 538. — Secketakt.] 

No. LY.— July 1854. 8 



110 Morland; Extracts from Soc. for Med. Improvement. [July 



tincture of iodine in the thorough manner recommended by Dr. Durkee ] it 
is, at any rate, not probable that they have poured it upon the part affected, 
and rendered the surface nearly " black" with it. Now, if Dr. D. and others, 
assert nearly universal success in arresting the disease by this method, we 
may be said to have commenced^ at least, the accumulation of "precise evi- 
dence" in favour of the iodine, and particularly of the ethereal tincture. 

Dr. Otis regards abortive treatment in "periodic erysipelas," as particularly 
reprehensible ; the application of collodion, however, he had observed to be 
attended, apparently, with advantage. If the tincture of iodine or any other 
local application be proved sufficient to arrest the progress of erysipelas, 
what " disadvantage" can there be in the mere concealment of the affected 
part by such application ? 

For the tincture of iodine, however, we contend that it does not "conceal" 
the processes going on beneath it, even when applied in the liberal manner in 
which Dr. Durkee uses the ethereal tincture. 

It should be distinctly stated that physicians here rely mainly, and from 
the first, upon constitiitiotial remedies ; tonics, and especially quinia, with 
wine and other stimulants, are freely administered. The advantages of cer- 
tain local applications can hardly be denied in the face of strong testimony in 
their favour, and if any of them will safely and efficiently check the progress 
of the disease and hold it in check, thei/ are to be preferred, of course, to 
mere palliatives, and are of exceeding value combined with constitutional 
means. 

Dr. Wood {U. S. Dispensatory, 6th ed., 1845) thus distinctly recognizes 
the power of the tincture of iodine in arresting the erysipelatous inflamma- 
tion : " It (tincture of iodine) is much used in this state (i. e. undiluted) in 
erysipelas, &c., and often with very happy effects. But its application re- 
quires some caution ; we are in the habit rather of surrounding the inflamed 
surface with a border of the tincture, embracing a portion of both the sound 
and the diseased skin, so as to prevent the progress of the inflammation, than 
of attempting a complete cure by covering the whole surface affected." — 
(Op. cit. p. 1175.) — Secretary.] 

Imperfect Physical and 3Iental Developments, in a Child horn in Breech- 
presentation, and with difficulty resuscitated from its asphyxiated condition. — 
Dr. MiNOT had met with the above case, which was similar to others reported 
by Drs. Grould, Storer, and Alley. The child, at the age of six years, could 
not walk alone, and had only partial control over his arms. There was stra- 
bismus ; articulation was imperfect, and the mental faculties were very feebly 
developed. 

April 24. Encysted Gelatinous Tumour of the Neck. — Removed by Dr. 
Nathaniel Miller, of Providence, R. I., April 8, and sent to Dr. B. S. 
Shaw, of Boston, who, through the Secretary, communicated the following 
account: The tumour was deep-seated beneath the sterno-mastoid muscle, 
and moving upwards and downwards in the act of deglutition ; about three 
inches in longest diameter, oval, but not quite so thick as broad. It was 
diagnosed as an encysted tumour containing a fluid of some kind, but, on 
cutting down upon it, it was found to have a glandular and solid appearance. 
The tumour was closely attached to the trachea, and after having dissected 
out rather more than half, the hook slipped in and revealed its nature. 
A part of the sac having been cut away, the remainder was cauterized and 
allowed to suppurate. The patient was an English woman, set. 32, married. 



1854.] Morlandj Extracts from Soc. for Med. Improvement. Ill 



The membrane of the cyst was quite thick and firm, measuring about a 
quarter of an inch in diameter, and a purely fibrous structure ; no lining epi- 
thelium seen. The contents had exactly the appearance of calf's-foot jelly, 
or of a dense jelly with the colour of brown sherry wine. It was perfectly 
transparent. In its structure it was amorphous, filled with the finest granu- 
lations, and with a few old and dried blood-globules imbedded in it. Jt was 
insoluble in boiling water, but soluble in alkalies, and from these solutions 
again precipitated by acids, showing its nature to be albuminous and not gela- 
tinous. A small quantity of fluid substance of the same colour, escaping with 
the jelly, was found to coagulate by means of heat and acids. 

This tumour seems to be of the same nature as a gelatinous encysted tumour 
of the breast exhibited to the Society last November, except that, in that case, 
the jelly was of a more fluid kind, and presented a variety of colours, probably 
owing to blood in different stages of decomposition. 

The specimen was exhibited to the Society. 

Dr. J. B. S. Jackson asked if it were connected at all, originally, with 
the thyroid body? Such a connection was supposable and not unlikely. 

[Dr. Shaw cannot learn from the original communication that there was 
any connection of the tumour with the thyroid gland. It would seem likely 
that Dr. Miller would have mentioned the fact had such been the case. — 
Secretary.] 

Peritonitis. — Dr. Shattuck reported three cases, with the following pre- 
fatory remarks : It has been noticed that uncommon and unusual cases are 
apt to be observed in close sequence of time and place. Three cases of 
peritonitis have been lately observed, two in the same bed, and one in an ad- 
joining bed, of one of the small wards of the Massachusetts General Hospital. 

A tall, well-formed man, 53 years of age, was admitted into the Hospital on 
the 21st of March, 1854. He belonged to a rheumatic family, had sufi'ered 
for years from rheumatic pains of the shoulders, had had two attacks of scia- 
tica, and in his occupation as a peddler had been exposed to alternations of 
temperature. He was complaining of weakness, stiffness, and pain of the 
lower extremities, from which he had been suffering for nearly a year. The 
pain commenced in the sole of the left foot, and extended up the legs as high 
as the lumbar vertebrae. He walked about the streets with a cane till the 
ground was covered with snow, when he confined himself to the house. He 
could get about by taking hold of the furniture, till within a week or two, 
when he has needed the assistance of some person. Constipation; within a 
few months, occasional dysuria, and retention of urine ; and within a few 
weeks incontinence. Nothing remarkable to the eye or touch about legs or 
back. Tickling soles of feet followed by disagreeable sensation and spasmo- 
dic movements of legs, which are sometimes drawn up of nights. This con- 
dition did not vary much for a few days. Constipation not easily overcome ; 
uncomfortable sensations about bowels, back, and legs, rather than pain ; 
increased difficulty of moving, so that he required assistance to be turned in 
bed. On the 1st of April, he complained of abdominal pain. On the 4th, 
the abdomen was full, resonant, and rigid ; the scrotum was red, cedematous. 
There were two inguinal hernias, that of the right side of fifteen years' stand- 
ing ; it was reduced with but little difficulty. The urine passed in bed ; the 
pulse 108, small, feeble; restlessness and discomfort; a large enema, followed 
by two free dejections. He took a grain of opium every three hours ; failed 
rapidly; and died at 6 o'clock on the morning of the 5th. 

At the autopsy, several ounces of pus were found in the peritoneal cavity. 



112 Morland; Extracts from Soc, for Med. Improvement. [July 



Injection of the serous coat of the intestines, as well as of the membrane 
lining the walls of the abdomen. No adhesions of the intestines; that part 
which had protruded through the inguinal canal could not be made out. The 
hernial sac empty; its lining membrane red, with shreds of false membrane; 
the scrotum, of the size of both fists, oedematous. 

Here we have an attack of peritonitis, without known cause, in a patient 
the subject of rheumatic attacks, and with partial and increasing paralysis of 
the lower extremities of a year's standing. 

An Irish labourer, who gave his age as 43, but who looked to be at least 
ten years older, and yet as if he had had a good constitution, was received into 
the Hospital on the 18tb of April, 1854. He had lived in Boston or its 
neighbourhood for twenty-two years ; his health had been good, but he had 
come from the country a fortnight before, on a visit, and had been indulging 
himself in eating and drinking. He had some pain in the stomach a week 
before his entrance, but kept about, and on the 14th, four days before his 
entrance, after eating freely, he was seized with severe abdominal pain, no 
vomiting; constipation; and he took salts on the 15th, and went out. On 
the 16th, pain in right hypochondriac region, with chills, pain in back and 
abdomen, and he was obliged to go to bed, and to stay there. On the even- 
ing of the 18th, he presented the aspect of a man labouring under severe 
acute disease; the countenance dusky, petechial eruption on limbs and trunk, 
abdomen red from sinapisms, moderately full, the patient not complaining 
much on pressure. Flatness over lower right back; bronchial respiration; 
no r^le. Pain in right hypochondriac region. Tongue brown, dry ; nausea ; 
occasional bilious vomiting. He died early on the morning of the 'iOth. 

Autops^y. — The pericardium not adherent, containing six or eight ounces of 
reddish fluid, with flakes of yellow lymph. Surface of heart dotted over with 
soft lymph, that of right auricle had a striated and ecchymosed appearance. 
Two quarts of serum, with lymph, in right pleural cavity; two lower lobes of 
right lung carnified. Abdomen. — The intestines glued together by recent 
lymph. Pus and lymph difi"used over the surface of the parietes and the 
viscera, particularly about the duodenum and liver. Duodenum much en- 
larged; small round perforation at the bottom of an old ulcer^ close to the 
pyloric orifice of the stomach. 

Intemperate eating and drinking seem to have been the determining causes 
of the rupture of the duodenum at the bottom of an old ulcer ; and probably 
this took place in a very limited extent six days before death. The symp- 
toms were not very severe, and he kept about for two days, and then the pain 
and vomiting returned, and he rapidly sank. It is worthy of notice that 
under these circumstances pleurisy and pericarditis should have supervened. 
The diagnosis at the time of entrance was not made out. He then com- 
plained of pain in the hypochondriac region, but the abdomen was not painful 
on pressure, nor was it tympanitic. He was much prostrated, and it was 
quite evident that he was sinking under very severe acute disease, the nature 
and extent of which were not to be ascertained in one so weak and sufi"ering 
so much. In the third case the result was favourable, so that there has been 
no opportunity of confirming the diagnosis by inspection. 

A Swede, 27 years of age, of a healthy family and of good general health, 
had a febrile afi"ection, with diarrhoea, commencing about the 20th of Decem- 
ber, and was confined to his bed for a month, and has not been able to work 
since, for more than a few days at a time, though he had tried to do so two 
or three times. On the evening of April 4, abdominal pain, weakness; and 
he came to the Hospital on the Gth. On the 7th^ he was found sitting up; 



1854.] Morland, Extracts from Soc. for Med. Imjorovemenf. 



113 



cheeks thin, with an hectic flush; expression of weakness and pain, complaining 
of languor, restlessness, occasional nausea and vomiting. The pulse 120, small; 
the abdomen tympanitic, full, quite tender on pressure; constipation. Nau- 
sea and bilious vomiting continued during the day; he was very restless at 
night; the abdominal pain relieved by hot fomentations. He was ordered to 
take, on the 8th, two grains of opium every four hours, and at night the same 
quantity every three hours. The nausea, and vomiting, and restlessness, and 
pain disappeared ; he slept but little till towards the morning of the 9th, and 
was sleeping soundly at the time of the visit, and sweating profusely. He 
drank freely of rennet-whey and lime-water, and took two grains of opium 
every three hours. He reported himself as very comfortable on the 10th, and 
asked for food; the pulse 118; the abdomen full, tense, tympanitic, not ten- 
der on pressure. On the 11th, he was found sitting up, dressed, and he 
begged for food. The abdomen was still tense and tympanitic; no dejection 
since his entrance. He took two grains of opium every three hours on the 
11th and 12th, when he reported having been to the water-closet, and having 
had two free dejections. On the 15th, he had taken two quarts each of arrow- 
root and of rennet-whey. On the 17th, the pulse 88 ; the abdomen soft, not 
painful on pressure. He was ordered to take the opium pills once in twelve 
hours, and on the 19th to take them only at night; and on the 21st, they 
were omitted ; on the 22d, he was allowed to take bread. On the 24th, he 
was put upon house diet, and allowed to go out, and has since been gaining 
strength and flesh; the bowels regular; no pain ; the digestion easy. 

Had this man typhoid fever in December and Januar}^ ? Was there any 
perforation in connection with an old ulceration ? How far had the treat- 
ment anything to do with the successful issue? These are some of the ques- 
tions open to members of the Society. 

Ahsces!^, confaimrig Hair, on the Nates. — Dr. J. Mason Warren had met 
with three cases of abscess of the nates connected with a fistulous opening 
over the coccyx, containing hair. The last case is a type of the two others. 
The patient, a young man, 20 years old, had for some time suffered from an 
irritation on one of the nates. Finally, an abscess formed and broke, fol- 
lowed shortly by one on the opposite side, both being the sources of great 
discomfort, the first having become fistulous. On separating the nates. Dr. 
W. at once discovered, about an inch below, in the median line and over the 
coccyx, a small aperture, about large enough to admit a probe, looking like a 
pit in the skin, and lined with epidermis. A probe, being introduced, pene- 
trated to the depth of an inch and a half. 

From his experience in the two former cases. Dr. W. was at once able to 
say that it led to a cavity containing hair, which was probably the origin of 
the abscess in the neighbourhood. An incision being made into this canal, 
it was found to terminate in a suppurating cavity, in which, lying quite loose, 
was a small bundle of hair. Radiating from this cavity were two canals 
leading to the abscesses in the nates mentioned above. 

It would seem probable that originally the hair was contained in a cyst, 
which, from the irritation caused by sitting, had suppurated, and the pus had 
burrowed in different directions. 

Dr. Jackson referred to a specimen, in the Society's Cabinet, of a lock or 
pellet of hair taken from near the umbilicus. 

Ovarian Tumour v'eigJiing Twenty-six Pounds. — The case occurred in the 
practice of Dr. Geo. Hayward, Jr., and was reported by Dr. Alley. 
The patient, a woman, forty-one years of age, of fair complexion, robust, 



114 Morland, Extracts from Soc. for Med. Improvement. [July 

and active, mother of four well- formed children; nothing ahnormal in their 
births. Had enjoyed good health until a year ago last February, when 
she began to feel some uneasiness in her abdomen, without swelling. Her 
catamenia ceased at that time, and continued suppressed until July, when a 
discharge of blood occurred, which continued at intervals for ten days. Her 
abdomen began to increase in size, and occasioned suspicions of pregnancy, 
which a careful examination, however, failed to establish. The discharge of 
blood continued at intervals, and the swelling of the abdomen increased till 
March, 1854, at which time the abdomen was punctured, and a pailful of fluid 
was drawn off, of so great density that it flowed with great difficulty through 
the canula, and it was necessary to clear out the tube occasionally to make it 
flow at all. Not long after, she died. At the autopsy, upon laying open the 
cavity of the abdomen, a large ovarian tumour was seen extending completely 
across the abdomen, crowding the viscera of that cavity into a very small 
space. 

The tumour weighed twenty-six pounds, with the contained fluid. It was 
divided into three distinct cavities or cysts, with walls of unequal thickness; in 
one portion, of bony hardness, and in another, breaking from the mere weight 
of the tumour. One of these cavities contained a serous, sanguinolent fluid, 
which flowed readily. The other two were filled with a ropy, tenacious semi- 
fluid, of such density that it could be cut across with a knife while flov/ing 
from the cavity. The tumour was attached to the uterus by a single pedicle, 
which, being severed, left the uterus remaining of normal size, and with some 
thickening of the cervix. 

Use of Butyric Acid Ether for flavouring Ice- Cream ; with a Sample of 
the flavouriny^ and of the flavoured article. — Dr. ALLEY read the following 
account, furnished by Dr. A. A. Hayes. 

The sample of ice cream and the flavouring essence used abundantly in 
preparing it, now exhibited, were intended to form part of the refreshments 
ofi'ered at a festival in Beverly, Mass. Some of the attendants, having tasted 
the ice-cream soon after it was made, and before it was sent to the place of 
meeting, were rendered quite sick within three hours after eating it, and the 
apprehensions felt by their friends, joined to their own fears of poisoning, 
produced much excitement in the town. 

These substances were placed in my hands for chemical examination. The 
flavouring substance, having the odour of the pine-apple, proved to be butyric 
acid ether, dissolved in spirits. It is well known that butyric acid is a pro- 
duct of fermentation, in which animal organized matter breaks up and reunites 
the elements of other organic matter, such as sugar. It is usually found in 
rancid butter, and in decomposing flesh and other animal matters at that stage 
when the exhalations are supposed to be infectious. This acid, united to the 
base of ordinary ether, constitutes the flavouring ingredient resorted to in this 
case, and it was free from any mineral poison. The ice-cream presented the 
usual character of a nicely prepared article, in which mostly cream was used 
instead of milk, and it was entirely free from any mineral body, of unusual 
occurrence. When subjected to chemical trials, the first odour of the butyric 
ether having passed ofi", butyric acid was detected, and the cream seemed to 
have passed, through the presence of the hutyric ether ^ to an advanced state of 
rancidity. Although the low temperature at which ice-cream is kept might 
be supposed an effectual guard against any chemical change in which butyric 
ether may be considered as playing the part of a ferment, yet it is also well 
known that sugar is produced in milk and in organized vegetable matter in 



1854.] Morlandj Extracts from Soc. for Med. Improvement. 115 



the act of freezing. Sugar thus formed, together with that added to the cream, 
may react with the elements of butyric ether, at a low temperature, to pro- 
duce butyric acid, or incipient compounds may result, which at common tem- 
peratures are converted into butyric acid. 

A number of flavouring extracts, equally objectionable, are largely con- 
sumed by confectioners as substitutes for the volatile oils, and cases of 
severe sickness and alarm are multiplied every season from the practice. 

In reference to this subject, Dr. John Bacon, Jr., remarked as follows: 
The production of poisonous effects by the artificial flavouring extracts which 
are now coming into general use is a subject of practical importance, even if 
no more serious results should follow their use than sickness and vomiting, as 
occurred in the case above reported by Dr. Hayes. In that instance, it 
is possible, though not probable, that a spontaneously poisonous condition of 
the cream might have occasioned the illness, as such cases are on record. 
The artificial extracts were first prominently brought forward at the London 
exhibition, and were reported upon favourably by the chemists on the jury 
(Dr. Hofmann and De La Rue), as entirely safe substitutes for the volatile 
oils prepared from plants. It appears to have been assumed that the artificial 
products were identical in chemical composition and in properties with the 
natural ones which they resemble in flavour, in which case there could be no 
objection to substituting less expensive modes of preparation. In some cases 
they are certainly not identical,; and, where any doubt exists, they should be 
used with great caution until positively ascertained to be harmless in their 
action on the system. 

Dr. J. 31. Warren said he had been called to a family in which seven per- 
sons had been more or less poisoned by custards largely flavoured with "extract 
of vanilla," so termed; on analysis, nothing of a poisonous nature could be 
detected ; yet, undoubtedly, the symptoms were referable to the said extract, 
which a cook, new to the family, had liberally used. 

Dr. W. E. Townsend referred to cases of illness caused, to all appearance, 
solely, by the eating of what are termed the acidulated drops,'' and, par- 
ticularly, of those termed " banana drops;" — he believed that one death, at 
least, in this city, during the last summer, was to be ascribed to their use ; 
and certainly several instances of apparent poisoning, declared by severe sick- 
ness at the stomach, &c. &c. 

[The editor of the Annual of Scientific Discovery, for 1853, remarks as 
follows in relation to the " acidulated fruit-drops :" — 

" These have been denounced as poisonous by some persons, on the ground 
that fusel oil is known to produce deleterious effects ; and, as a natural con- 
sequence, the confectionery referred to has been discarded. There is, how- 
ever, no foundation for such statements or belief ; and if the confectionery, 
flavoured with these extracts, has in any case produced injurious effects, it is 
undoubtedly to be referred to an injudicious consumption of it, and not to 
any inherent deleterious property." — Op. cit. p. 228. 

' This is certainly very positive language, and suited rather to reassure the 
somewhat daunted consumers of the said confectionery ; with all due defer- 
ence to so high chemical authority, however, it may be safely asked if there 
are not, undoubtedly, every day, instances of quite as " injudicious," and even 
more plentiful consumption of many other confections without any sucli effects 
as have been frequently observed immediately after using the kind under con- 
sideration. If this be admitted, do we not naturally look for some peculiariti/ 
in the confection after whose ingestion these effects are so often noticed ? 
What, then, is the agent thus (seemingly, at least,) active ? If such effects 



116 Morland, Extracts from Soc. for Med. Improvement. [July- 



be common, will not the 'Mrops/' and such like articles, be avoided at any rate? 
In perusing the entire article, upon Perfumery, and the Artificial Extracts of 
Fruit,'' [op. sKj). cit.j) one can hardly escape being impressed with the feeling 
that the processes by which they are obtained, and their use, have been too 
readily sanctioned by the distinguished chemists whose names have been 
mentioned, and that more certain knowledge of their effects (occasional, at 
least,) upon the human system should be had before recommending them 
so fully. — Secretary.] 

31ai/ 8. Fatal Peritonitis from Perforation of tlie Duodenum. — Dr. Jo- 
seph Sargent, of Worcester, associate member of the Society, sent the speci- 
men, which was exhibited by the Secretary, who read the following account of 
the case, furnished by Dr. S., who remarks that he thinks it a very rare one, 
and that it is the only one he had seen. The patient was a farmer, 35 years 
of age, and of large muscular development; he died April 28. He had, for 
months, complained of a feeling which he termed a feeling of goneness^' at 
the epigastrium, and had been troubled with flatulent eructations and occa- 
sional vomitings of green liquids, and had " distressed turns' at night, the 
distress being in the region of the transverse colon, and " worhing off" (as he 
expressed it) with diarrhoea. With all this, he had done rather less work than 
usual, but rode fourteen miles to Worcester, on a lumber-wagon, April 26, 
after having, on the previous day (only two days before his death), laid stone 
wall in the morning, and was sick in the afternoon, so as to vomit freely, 
which relieved him. He, however, ate no supper; was restless during the 
night, and rose early the next morning (27th), " feeling like death,'' and 
walked his room; ate but little breakfast; started upon his lumber-wagon for 
Worcester at 7 o'clock A. M., and arrived about 10 o'clock; felt very uneasy 
while riding, so that at last he got off the wagon and walked. At about 11 
o'clock A. M. (April 27), while standing in a store in Worcester, he was seized 
with sudden distress in the right hypochondrium, so severe that he threw him- 
self upon the floor, and lay there an hour or two, during which time he took 
something hot, with brandy, from an itinerant physician. Dr. S. saw him at 
4 P. M., and found him complaining of severe pain in the region of the trans- 
verse colon, and also of pain in his shoulders. His abdomen had the hardness 
often observed in tetanic patients, and was not tumid, tympanitic, nor tender 
on pressure. With the view of inducing some relaxation of the abdominal 
muscles, and of facilitating an examination. Dr. S. allowed him to inhale a 
little chloroform, without procuring much relief to the pain or obtaining mus- 
cular relaxation. A teaspoonful of black drop was then given ; and subse- 
quently some calomel and ipecac caused emesis, and seemed to give slight 
relief. He took opium, however, nearly every hour through the night, and 
yet slept but little. At 8 o'clock A. M. of the 28th of April, he was vomit- 
ing incessantly a thin, yellowish liquid ; pain somewhat diminished ; tendency 
to be cold, with clammy perspiration; he was pulseless; intellect clear. There 
was now great tumefaction over the entire region of the transverse colon, with 
tenderness; abdomen still very hard; no hiccough. He still complained of 
pain in his shoulders, to which he had long been subject. He remained in 
this condition till about 3 o'clock P. M., when he died, twenty-eight hours 
after the acute attack. 

Post-mortem examination, eighteen hours after death. — General peritonitis; 
serum, pus, and lymph in the abdominal cavity; universal injection of the 
peritoneum, with agglutination of some folds of intestine; inflammation most 
intense in the region of the transverse colon and stomach ; three or four cica- 



1854.] Morland, Extracts from Soc. for Med. Improvement. 117 



trices of ulcers in the mucous membrane of the duodenum, through the centre 
of one of which, very near to the pylorus, and in immediate contiguity to most 
intense inflammation, a circular perforation was discovered. The intense in- 
flammation was not in the ulcer, nor in the duodenum, but in the folds of 
intestine lying over the latter. The base of these ulcers (which do not seem 
to be recent) is the muscular coat of the intestine. 

Cauliflower Tumour of the Uterus (Sir Charles Mansfield Clarke). Tu- 
meur Polypeuse cle Nature Vegetante et Fihro-plastiqiie (Lebert). EpitlieUal 
Cancer of the Uterus. — Dr. Sargent sent the specimen to the Society for 
their Cabinet, having observed that it contained none such. Dr. S, remarks 
that the tumour is rare, and that the usual mode of extirpation, by ligature, 
destroys the specimen. Dr. S. sent the following account: "I operated by the 
knife, arresting the hemorrhage by the actual cautery, and also by plugging 
the vagina with sponge filled with powdered alum. The patient was 47 
years of age, and of irregular menstruation. She had had nine children, the 
last born five years ago. For six months, there had been unusual vaginal 
hemorrhage, which, for three months, had been slightly olFensive, though the 
fetor has not been such as to be noticed by the friends. There had also 'been 
abundant watery discharges from the vagina. On examination, I found a 
long, cauliflower-form growth, springing from the upper lip of the os uteri 
(which latter was itself very juuch elongated and attenuated, but soft and 
healthy), and filling the whole vagina so as to present itself at the vulva. 
The OS uteri was open, so that T could readily pass my finger into the uterus ; 
the fundus of the organ was soft and natural; there was nothing abnormal in 
the feeling of the bladder or rectum ; no glandular enlargement in the groins, 
nor tumours to be perceived in the abdomen, on palpation. Subsequent 
examination by the speculum showed the uterine tumour to be lobulated on 
its vulvar surface, and to be covered with an abundant jelly-like mucus. 

The patient complained especially of weakness and of morbid excitement 
and wakefulness. All her functions were well performed. The tumour was 
increasing so fast that it would soon be troublesome by its bulk, while it was 
already exhausting the patient by the anxiety which it induced as well as by 
the discharges it occasioned; and I removed it, in the manner above stated, 
on the 14th of March. On the 7th of April the wound was nearly healed, 
and the patient was about her house and doing very well. The local treat- 
ment after the operation, and after suppuration was established, was by alum 
injections daily, with the occasional application of nitrate -of silver. 

Ahscess of the Tibia: Trephining of the Bone, &c. — A section of the tibia 
upon which the above operation was done, was sent by Dr. Sargent, and ex- 
hibited to the Society; it shows great thickening of the bone by reason of 
inflammation. Dr. S. operated last week upon the patient, a young man of 
27 years, who had had periostitis of the left tibia, near the knee — perhaps 
owing to a blow — for eighteen years, at times with exfoliation, and, until quite 
recently, with little tumefaction. During this period of eighteen years, the 
patient had, however, been free from pain most of the time ; he had been able 
to complete a collegiate and professional education, but had always been sub- 
ject to seizures of severe pain in the region indicated, with soreness, and also 
with pain in the course of the sciatic nerve; there were also disturbance of 
the digestive system, and, occasionally, wandering neuralgic pains. Within 
the past year these attacks had been more frequent than before, and much 
more severe, so that the patient had been confined to the house much of his 



118 Morland, Extracts from Soc. for Med. Improvement. [July 

time. The leg had become considerably flexed, and any extension or motion 
whatever was painful. For two months past the swelling had been gradually 
increasing, and obviously it was an enlargement of the honey as well as a thick- 
ening of the periosteum ; it was quite tender to the touch, and finally became 
oedematous over its surface. The pain was so severe that the patient often 
begged for amputation. The joint was entirely unaflFected. Gleneral health 
good, except for disturbance by pain ; no rigors. Dr. S. trephined the tibia 
April 23, 1854, perforating it just below and within the insertion of the liga- 
ment of the patella, and opened into an abscess, from which there issued per- 
haps two ounces of creamy pus. The periosteum over the seat of the disease 
was more than half an inch thick, and the bone, as seen in the specimen, 
greatly thickened. The patient had some pain following the operation, but 
has been entirely relieved since; he is gradually acquiring the power of 
motion with the limb. 

Ouarian Disease, with Specimens, &c. — Sections of the diseased ovaries 
were sent by Dr. Sargent, and were exhibited to the Society by the Secretary, 
who also read the following account of the patient's case, furnished by Dr. S. : — 
A maiden lady, 34 years of age, first examined by Dr. S. in August, 1846 
(aged, then, 26 years}, was, at that time, ascertained to have the entire pelvis, 
as examined by the vagina and by the rectum, filled with lobulated disease, 
which did not seem to be of scirrhous hardness, nor to have invaded the os 
uteri. Dr. S. has examined her about once a year, sioce the first exploration, 
and has found the abdomen to be gradually filling up with a tumour which 
was not fluctuating, while the general health had remained tolerably good. 
It is now about two years since Dr. S. last saw her, living. Her health, this 
spring, had been as good as usual, so that she was occupied in domestic affairs, 
and had a good appetite up to the 3d of May, when she was induced to submit 
to an attempt at extirpation of the diseased mass by an itinerant surgeon, 
who told her that her chances of cure thereby were as three to one. She 
died three days after the operation, with symptoms of peritonitis. The 
autopsy was performed twenty hours after death. The integument of the de- 
pending parts of the body was much discoloured, and there were several 
ecchymoses, with bloody serum beneath the cuticle, about the lower part 
of the abdomen, which latter was as much distended as in pregnancy at 
the full term. An incision of about three inches in length had been made 
through the abdominal parietes, just at the right of the umbilicus, and 
a little below it, from which wound a bloody fluid was escaping. The ab- 
domen had also been punctured a little below and to the right of this above- 
mentioned incision. On cutting through its walls, the whole cavity of the 
abdomen seemed to be filled with a large tumour, which covered the intestines, 
to which it was attached by some old adhesions, especially in the epigastrium 
and on the left side of the abdomen. There were also slight adhesions about 
I the umbilicus, and some traces of pus and of recent lymph in the same region; 
but the general investment of the tumour presented a smooth serous surface, 
•which was about two feet in every diameter, but divided, transversely, by a fis- 
sure, which was found afterwards to be between the two ovaries, which organs 
haA contracted adhesions to each other that admitted of easy separation ; the 
right ovary constituting the larger part of the mass, and rising so as to fill the 
right hypochondrium, the epigastrium, and the left hypochondrium, leaving 
only the space from the umbilicus to the left lumbar region, and to the left 
groin, for the other ovary. Along this said fissure the Fallopian tubes could 
be traced, each about eight inches long, with their fimbriated extremities open, 



1854.] Morland, Extracts from Soc. for Med. Improvement, 119 



admitting a sound. The round ligaments of the uterus were also seen pass- 
ing under the investment of the tumour, to the groins. The whole mass 
removed weighed 46 J pounds. On dissection, the vagina was found to be 
elongated to seven inches; the os uteri almost obliterated by attenuation; the 
body of the uterus itself being elongated to fourteen inches, reaching upwards 
over the whole of that portion of the tumour which was afterwards found to be 
constituted by the left ovary, which itself presented a surface of about twelve 
inches square. The anterior wall of the uterus was quite thin, perhaps one- 
eighth of an inch in thickness, while the posterior wall was half an inch thick. 
The upper part of the uterus was filled with a coagulum; the uterus itself was 
found to be perforated by a trocar, which the " surgeon" above referred to 
had passed quite through both walls of the organ, prior to his capital opera- 
tion ; the puncture extended from the uterus into the left ovary, in and about 
which there was extensive ecchymosis (nearly a pint of blood was said to have 
flowed through the canula of the trocar, before its removal). The left ovary 
was about one foot square on its surface, and six inches in thickness; the 
right ovary was about one foot, cube. The structure of both was analogous, 
and throughout was like the specimens exhibited to the Society, and which 
are sections, one from each ovary. The bladder and vagina were healthy. 
Riyht ureter dilated to the size of a finger; and the pelvis of the Mdney was 
-SO enlarged that the kidney itself was only a sac of urine. Left Iddney per- 
haps three times the natural size, and unusually friable; the broken surface 
resembling that of the spleen, while the lining of its pelvis was dark, by dis- 
tension of the venous capillaries. Lungs free from adhesions, excepting slight 
ones at their apices ; their general surface dark, by venous congestion ; no 
tubercles. Dr. S. adds, that it is understood that the surgeon" gave up bis 
operation because he found adhesions. 

Dr. B. S. Shaw, who examined a portion of the specimen microscopically^ 
pronounced its structure to be fibrous. No trace of cells visible. 

Dr. Sargent presented to the Society, with the above specimens, the iden- 
tical pitchfork, upon the handle of which a lady was impaled to the extent of 
tweuty-two inches, the handle entering the vagina. (See Amer. Journ. of 
Med. Sciences, Oct. 1853, p. 355.) 

Irregularities in Measles. — Dr. PuTNAM referred to some cases of measles 
4hat he had reported some time since, showing that the irregularities in the 
disease had, during the present season, been unusually frequent. He further 
read the following history of three cases, communicated to the Society by Dr. 
James Jackson : — 

The following is a case of idiosyncrasy in resisting the measles, which was 
finally overcome. It is the more remarkable, as it was transmitted to the 
ofi'spring, and modified the disease in them. In regard to the facts, I should 
believe that some error might have occurred, had not the subjects of them 
belonged to my own family. 

F. H. was exposed to measles in early childhood. He was with a sister 
who had the disease, and was himself unwell. I remarked, at the time, that 
he had the constitutional afi"ection, so that if he had had any eruption, I should 
say he had had the disease. I do not now recall the particular symptoms show- 
ing the constitutional affection ; but, at the time, I regarded them as being 
characteristic of the disease. Since that time, he has been exposed, more 
than once, to the measles, without any result as to himself. 

He has two children. The oldest, a boy, was taken sick on the 81st of 
December, 1853, with a sore throat and febrile symptoms. We were looking 



120 Morland, Extracts from Soc. for Med. Improvement. [July 

for tlie measles in him. He had not any affection of the eyes, nor of the 
nose. The affection of the throat was principally in the soft palate, at its mar- 
gin, which was red, swollen, and painful. This continued five days, during 
which he kept mostly on a couch, but walked about occasionally, and had not 
much appetite. There were not at any time distinct spots on the palate, such 
as frequently precede and attend measles. On the fifth day he appeared bet- 
ter; but, after the morning, he discovered an eruption, which had the distinct 
characteristics of measles, about his elbows and about his knees, mostly on the 
latter. This subsided on the third day from its appearance, and left him well, 
though somewhat emaciated and enfeebled. In the two following days (the 
8th and 9th of the disease), he convalesced rapidly; on the 10th and 11th, 
he walked abroad, and at his own request he went to school on the 12th, 13th, 
14th, and 15th. On the IGfch, he had a rheumatic pain, with some slight 
constitutional affection; the pain was less on the 17th, but the fever more; 
on the 18th, there came on an eruption of measles on his face and breast, 
which spread rapidly over the body. It was very full, and strongly marked 
in every respect. He was somewhat prostrated at this time, and coughed 
much. The eruption abated on the third day, and terminated on the fifth. 
From this time he convalesced rapidly. 

It will be perceived that the full eruption occurred on the 19th of January, 
1854. 

On the 28th of January, the sister had an eruption of measles, preceded by 
a slight indisposition for two or three days, in which the eyes and nose were 
slightly affected, but the throat not at all. The eruption was on the face and 
breast, and afterwards on the other parts of the body, but was not full nor 
high coloured. The patient was on her feet much of the time. In the course 
of the fourth day of the eruption (January 31), when I looked for a decline 
of it, on the face at least, it began to increase in every respect, so that the next 
day it was very full and high coloured. The fever increased with this change, 
and on the next day it was quite severe ; she was entirely prostrated ; pulse 
very frequent ; skin hot ; and she had some delirium. She remained severely 
sick till the 5th of February, on which day the eruption faded, and from that 
day it subsided slowly. During this serious attack, the passages of the nose 
and one ear were very much affected, as sometimes happens in scarlatina. The 
convalescence was very slow, and the ear has not recovered entirely at this 
time. May 6. 

On the 7th of February, the father was taken sick. He was chilly, and had 
a great feeling of soreness over the whole surface of his body. He did not 
lose his appetite, or only in a slight degree, and went abroad a little every 
day. At the same time, he had a sore throat. The tonsils were inflamed, and 
had white patches on them. The disease with the general symptoms continued 
till the 12th, when he was much better in every respect, and from that time 
the throat got well. But on the three days following the 12th, he felt sick again, 
and his countenance was much altered, and a loss of flesh was very manifest. 
On the 16th of February, he was much better, so that on the 17th, he went 
a journey of 200 miles into the country, which had been deferred on account 
of his sickness. He returned on the 20th, having encountered very cold 
weather, but felt very well. Yet on the night of his return, he discovered an 
eruption on his thighs and legs, though not on any other part of his body. 
On examination, the next day (21st February, and the fifteenth of his disease), 
I found that the eruption was that of the true measles. This continued four 
days, the general health not being disturbed. 

There are here shown three cases of remarkable irregularity in measles, all 



1854.] 



Bache, Pathology of Cases of Yellow Fever. 



121 



occurring in one family, a father and his two only children. Nothing of the 
kind had occurred in any of the progenitors of the father, so far as I know ; 
and I probably should have heard of it, had it occurred among any of his rela- 
tives in the generation preceding him. The cases differ from each other as 
to their course, but in each of them the rash came out with difficulty, and in 
both the children it burst out with violence after it had made one effort to 
show itself. In the father, there seemed to have been an effort to produce the 
disease when he was exposed to it in his childhood. Again, while he was 
exposed to it in his children, in his thirty-ninth year, a new struggle took 
place, such that I said to him he was affected by measles without an eruption. 
Then, after complete recovery, and while much exposed in cold weather, the 
eruption came out, but limited to the lower extremities. 

It is proper to add that the idiosyncrasy in these cases cannot be attributed 
to any feebleness of constitution. The father has always enjoyed good health, 
and so have his children. 



Art. Y. — Observations on the Pafhologi/ of Cases of Yellow Fever, ad- 
mitted into the PennsylvanitX Hospital durirtg the Summer of 1853. By 
Thomas Hewson Bache, M. D. 

It will be observed, of the fourteen cases on which post-mortem exami- 
nations were made, that the head was examined in four only. It is, therefore, 
necessary to state, to prevent wrong conclusions, that, in cases dying without 
any symptoms which indicated the probability of any lesion of the brain, the 
calvarium was not removed. 

Case I. — Examined thirteen hours after death. The external surface was 
of a bronze-yellow colour over nearly the whole body, with bloody discoloration 
of the scrotum and all dependent parts; rigor mortis being well pronounced. 
The dura mater was tinged yellow, and the vessels of the membranes were 
congested with venous blood. The substance of the brain, however, appeared 
healthy. In the thorax, some slight adhesions of the left pleura were found, 
which were of a yellow tinge. Both cavities of the heart were full of blood. 
The cavity of the pericardium contained a fluidounce of yellow fluid, which 
was tested for bile, and found to contain it. The stomach was red and some- 
what corrugated, and very much distended with a black fluid, in appearance 
similar to that which had been vomited before death. The small intestine 
contained a black fluid, which became more pasty and of a lighter colour as it 
was traced downwards, until, arriving at about three or four feet from the ileo- 
ccecal valve, where it ceased, it became of a lead colour. The liver was finely 
mottled with yellow and red spots. The microscope showed a great excess of 
oil-globules, not only in the secreting cells themselves, but floating freely in 
the field. The gall-bladder contained bile. On removing the right kidney, 
which was abnormally yellow, a large psoas abscess was found. 

Case II. — Examined sixteen hours after death. The general appearances 
of the external surface, as well as of the internal organs, were, with the ex- 
ception of the gall-bladder containing no bile, and both intestines being 
contracted, the same as in Case 1. 



122 



Bache, Patliology of Cases of Ytllow Fever. 



[July 



Case III. — Examined eleven hours after death. General appearances of 
the surface as in the above. The right pleural cavity contained half a fluid- 
ounce of orange-yellow fluid. The pericardium was injected. The liver, 
though darker in colour than in Case 1, was, like it, finely mottled. The 
stomach contained a black fluid, with some gas. Its peritoneal covering was 
congested, as well as its mucous surface; the latter more especially at the 
cardiac orifice. It showed, however, no sign of softening. 

Case IV. — Examined ten hours after death. A little fluid was found in 
both pleural cavities, and the pericardium was of a decided orange-yellow 
colour. The stomach was injected at the cardiac orifice, its contents being the 
same as in Case 4. Its mucous membrane, however, was softened, and, in one 
place near the larger extremity, ulcerated; the ulcerated places being of a 
black colour. This case was the first in which the cesophagus was carefully noted ; 
and this tube was found reddened, and denuded of its epithelial covering. The 
liver was tawny, with fine brown and red spots, and the gall-bladder nearly full 
of rich brown bile. The small intestine contained the same fluid observed in 
Case 1. The mucous membrane of the duodenum, for six inches, was red with 
efi"used blood, for six inches more, was covered with spots like ecchymoses; 
similar ones being scattered, here and there, down the intestine, to within two 
feet of the ileo-coecai valve. The large intestine also presented some spots at 
its commencement, and was filled with a thick slate-coloured fluid. 

Case Y. — Examined eleven hours after death. External surface as in the 
preceding cases. This patient having died suddenly with delirium, a few hours 
after his admission, the head was examined. Nothing was presented but venous 
congestion of the membranes of the brain, with the dura mater more tightly 
adherent to the calvarium than usual. This may have been occasioned by the 
Pacchionian glands, which were unusually large. The substance of the brain 
showed no alteration. The mucous membrane of the large bronchial tubes 
was highly congested, though the lungs themselves presented no lesions. The 
pericardium contained half a fluidounce of bloody fluid, with a small black clot. 
The right cavity of the heart contained a fibrinous clot, whereas the left was 
empty. The lining membrane of the aorta was very yellow. The stomach 
contained a dark coffee-coloured fluid. Its mucous membrane was not softened, 
and was, for the most part, of a leaden colour; still, both the greater and lesser 
curvatures were red, like a dysentery gut. The liver was reddish-yellow and 
mottled. The mucous membrane of both the small and large intestines was of 
a lead or slate colour, and filled with a fluid of the same hue, but was free from 
ulceration. 

Case VI. — Examined fifteen hours after death. The external surface was 
not exactly as in the other cases; probably because the examination was made 
after a longer interval from the time of death than in any of the preceding. The 
skin was of a much brighter yellow, and the dependent parts, though somewhat 
purple, had not the dark bronze hue so often seen. This, perhaps, may be 
accounted for by the fact that this patient died at a very late stage of his dis- 
ease, or rather from its after-effects, and not, as commonly, in the third stage 
(i. e. collapse); his attack assuming a protracted typhoid form. The peri- 
cardium contained as much as four fluidounces of yellowish-brown fluid, but 
exhibited no evidence of inflammation. The mucous membrane of the stomach 
showed signs of old inflammation, being of a mottled slate colour, the greater 
extremity of a brownish-green, and the pylorus red. It contained no black fluid, 



II 



1854.] Bacbe, PatMogy of Cases of Yellow Fever. 123 



but a fluidounce and a half of dark thick greenish matter. The whole oeso- 
phagus was in a state of sphacelation. The liver, with the exception of being 
soft and flabby, with the gall-bladder full of bile, did not differ from those 
observed in the preceding cases. The duodenum was inflamed; some of Peyer's 
patches were unusually distinct, and in their vicinity the gut was injected. The 
colon was much inflamed, particularly at its head; and near the sigmoid 
flexure there was a fibrinous patch. 

Case YIT. — Examined nine and a half hours after death. The pericardium 
contained about two fluidounces of gamboge-coloured fluid; whereas that of the 
pleura was bloody. The bronchial tubes were injected. The aorta and pul- 
monary artery presented a buff colour. The liver was different from those of 
the preceding cases, being of a pale-yellow or tawny colour, and the gall-bladder 
of a dark-red hue. The stomach showed signs of inflammation, as did also the 
intestines; the latter being of a slate-green colour. The contents of the former 
were very dark-brown, but, by transmitted light, of a claret colour. 

Cases VIIL and IX. presented similar lesions to those already noted. It 
is interesting to mention, however, that, in one of these cases, the larger biliary 
ducts were dissected out, and found to contain bile to all appearance healthy. 

Case X. — Examined nine Iiours after death. This case is one of peculiar 
interest, from the fact that the pericardium contained four fluidounces of a very 
turbid greenish-brown fluid, rcbembling black vomit, which, being poured into 
a bottle and allowed to stand a short time, separated into two portions; that 
at the bottom of the bottle being of a white or pale-yellow, while the rest 
remained of the original colour. An examination by the microscope proved 
the brownish-black fluid to be altered blood-corpuscles, with less of the granular 
amorphous matter than is usually found in the genuine black vomit. These 
blood-corpuscles were not as much altered as they generally are, when they 
constitute one of the elements of black vomit. No epithelial scales could be 
detected, although it was natural to suppose that they were present; since it is 
difficult to understand how a hemorrhage could occur from a serous surface 
without a loss of some of its epithelial covering. The whitish fluid was pus. 
The heart itself was stained of a dark colour at its base, and the pericardium 
was minutely injected in points. The stomach was uniformly red over all its 
surface, except at the cardiac orifice. Its centre presented a number of black 
spots of various sizes, like ecchymoses, and two ulcerated fissures, each about 
an inch long, filled with black matter, each of which corresponded to the track 
of a vein, found on the peritoneal side of the organ. The liver presented 
nothing different from the same viscus in the other cases. 

Case XL — Examined sixteen hours after death. In this case, the head was 
examined. All the membranes were injected and thickened; the hemispheres 
being partially adherent, and the right lateral ventricle containing some fluid. 
The other appearances were in no respect different from those in the other 
cases; except that the fluid found in the stomach (five fluidounces) was not 
black, but of a chocolate colour, and that half of the mucous membrane towards 
the pylorus was of a slate colour, the other half red. 

Case XII. — Examined fifteen hours after death, on the same morning that the 
preceding case was inspected ; the organs of the two cases being compared. The 
stomach contained as much as a pint and a half of thick black fluid. Its mu- 



124 Bache, Patliology of Cases of Yellow Fever. [July 

cous membrane presented the same colours as in the preceding cases; the slate 
colour, however, being towards the greater extremity. The appearance of the 
liver, intestines, &c., was the same as in the other cases. 

Case XIII. — Examined fourteen hours after death. The only difference 
worthy of notice was, that, although the stomach much resembled that of Case 
10, having one fissure more than an inch and a half long, yet no vessel could 
be detected to correspond to it. 

Case XIY. — Examined sixteen hours after death. This patient died in 
convulsions. The dura mater was much congested, some effusion being under 
it. The superior part of the arachnoid presented a number of opaque spots. 
The vessels of the pia mater were congested. The right lateral ventricle con- 
tained two fluidrachms of fluid; the membrane lining it, as well as the choroid 
plexus, being coogested. The substance of the brain appeared normal; 
although, when cut, the points which indicate its vessels presented a black 
instead of a red colour. The lesions of the other organs were very analogous 
to those found in the preceding cases. 

In reviewing the lesions presented in the above cases, those of the most in- 
terest, certainly, are the great excess of oil, found in the liver of all the fourteen 
cases by the aid of the microscope; and the fluid, resembling black vomit, 
observed in the pericardium of Case 10. Budd, in his work on diseases of the 
liver, makes some allusion to the probability of acute disease inducing fatty 
degeneration of that organ; for, at page 300 of the second edition, he says: 
^'In all cases in which I have yet ascribed fatty degeneration of the liver to 
local causes affecting the nutrition of the part, the accumulation of the fat has 
been partial. It may be, however, that the entire organ may be damaged by 
some acute disease, or in other ways, and may become fatty in consequence. 
I strongly suspect that this happens in yellow fever, and in the severe bilious 
remittents of tropical climates.'^ Dr. A. Clark, in a paper contained in the 
New York Medical TimeSj for May, 1853, called attention to the microscopical 
examination of the liver of a patient who had died of yellow fever; it having 
demonstrated "a fatty state of all the secreting epithelial cells, and an abund- 
ance of free fat-globules." He expresses a doubt as to whether the lesion is 
peculiar to yellow fever; as, in the case in which he made the observation, the 
liver may have been fatty before the attack of the fatal disease; and he puts 
the question to those who may have the opportunity of observing, " Is not the 
change so constantly observed in the livers of those dying of yellow fever, an 
acute fatty degeneration?'^ The paper of Dr. Clark is not now by us to refer 
to, and, consequently, we cannot compare his observations with those made 
in the fourteen fatal cases occurring at the Pennsylvania Hospital. However, 
in order that others may do so, we will describe the microscopical appearances 
of the liver in the hospital cases. The secreting cells were pale, ill-defined, 
and less granular than when in the normal state. In the cells, with few ex- 
ceptions, no nucleus could be detected, but its place was supplied by a single 
oil-globule. This was observed even in those cases in which the granular part 



1854.] 



Baciie, Pathology of Cases of Yellow Fever. 



125 



of the cells was not so full of oil as in some others. Generally, the cells were 
so studded with oil-globules as to give one the idea of looking at a number of 
these latter, which had by chance become agglomerated or entangled by granu- 
lar matter, leading to the conclusion that the cells were broken down. I am 
very sure we at first mistook some diseased cells for such oil-globules. Nor 
did the oil-globules confine themselves merely to the granular part of the 
cells and their nuclei; but they were found floating freely, of various sizes, all 
over the field of the microscope. 

These appearances were not only seen at the Pennsylvania Hospital, where 
they were frequently shown to physicians curious in such matters; but speci- 
mens of the morbid structure were sent to others familiar with the use of the 
microscope, and its application to pathology, who, in every case, confirmed the 
above conclusions. Moreover, several specimens, taken from the livers of 
persons who had fiiUen victims to the epidemic, and had not been admitted 
into the Pennsylvania Hospital, were sent there for examination, and found to 
present the same pathological appearances. From the above cases, are we not 
warranted in concluding that the liver of persons dying of yellow fever is a 
fatty liver? Indeed, may not the morbid change be called, as Dr. Clark has 
called it, ''an acute fatty degeneration?" 

Some may be curious to know whether the microscope shows any difference 
between the fatty degeneration above alluded to, and that occurring in the 
drunkard's liver. This question we have endeavoured to solve, and, from a 
careful examination of a limited number of specimens taken from persons of 
intemperate habits, must declare that we have not detected any. 

Louis, in his work on the yellow fever of 1828, at Gibraltar, page 162, 
describes the liver as being sometimes of the colour of fresh butter, some- 
times of a straw-yellow, a clear cofi'ee-and-milk colour, sometimes of a gum- 
yellow, sometimes of an orange colour." AYe saw no livers of the colour of 
fresh butter, and only two or three of a clear coffee-and-milk colour; one of 
which was brought from the St. Joseph's Hospital, and, therefore, is not enu- 
merated in the fourteen fatal cases we have tabulated. These livers seemed to 
have little or no blood in them, and were familiarly called by us the anemic 
liver. As a general rule, the livers we saw were of an orange-yellow colour, 
sometimes gamboge-coloured on the cut surfaces, finely granular, and be- 
coming redder by exposure to the air. 

The contents of the stomach, as well as many specimens of black vomit, 
taken at various times from different patients, were carefully examined by the 
microscope, and found to contain — 

1. Amorphous masses of coagulated mucus or serum, and the debris of 
blood-corpuscles, which gave the mass a red or brown colour. 

2. Numerous small irregular masses, sometimes presenting an imperfect 
crystalline form (probably altered hematin), which were of different shades, 
from a reddish-brown to a deep-black colour. 

No. LY.— July 1854. 9 



126 



Bache^ Patliology of Cases of Yellow Fever. 



[July 



3. Red blood-corpuscles, in different stages of alteration, which did not cor- 
respond to the degree of acidity of the vomit, 

4. Various forms of epithelial cells, as the squamous and conoidal. In one 
specimen, a perfect mucous crjpt was observed. 

5. Brown oil-globules, some of which bristled with fine crystals of margaric 
acid. 

Besides these constant elements, there were some occasional ones, such as 
the sarcina ventriculi and the torula, the former more frequently than the 
latter, and some inflammation corpuscles. 

Although the preceding cases, with the exception of the last two, occupied 
the medical wards of the Pennsylvania Hospital, during my term of service 
in those wards as resident physician; yet it is right to mention that Drs. J. 
E. Bhoads, James Darrach, and J. Green, also residing in the hospital in the 
same capacity, but having charge of the surgical wards, took part in the above 
investigations, and aided materially to give them whatever value they may 
possess. To the first-named gentleman, particularly, I am indebted for the 
notes taken during the microscopical investigations of the morbid specimens. 

The fatal cases, l5 in number, were all examined with but one exception. 

Summari/ of the Post-mortem Appearances. 



Generalities. — Examination made within 11 hours after death in 6 cases. 

H " 2 " 

17 " 6 " 

External Appearances. — Yellow of various shades in . . .14 cases. 
Bloody discoloration of dependent parts (no observation in 1) in 13 " 
Rigor mortis (no observation made in 5) in .. . . . 9 '* 
Conjunctiva yellow (no observation made in 8) in . .6 " 

The Head was examined in ........ 4 cases. 

Pacchionian bodies very prominent in 2 ." 

Dura mater firmly adherent to calvariuni in . . . . 2 " 

" congested in 3 " 

" thickened in 1 case. 

" tinged yellow in . . . . . . .2 cases. 

" had effusion under it in . . . . .1 case. 

Arachnoid opaque in . . . . . . . . 1 " 

Pia mater congested in . . . . . , . .3 cases. 

" thickened and opaque in . . . - ' . . 1 case. 

Hemispheres partially adherent in 1 " 

Structure of brain normal in 4 cases. 

Effusion into the ventricles in . . . . . . 2 " 

The Lungs were examined in . . . . . . . 13 cases. 

Structure normal in ........ 7 " 

Old adhesions (which were frequently tinged yellow) in . 5 " 

General congestion posteriorly in . . . . . . 2 " 

Congested in spots at posterior portion (ecch3mioses) in . 5 " 

Effusion of serum in 3 " 

" blood in ........ 1 case. 

The Trachea and Bronchial Tabes were examined in . . .8 cases. 
Injected in - . 8 " 

IVte P<erica?TZmw was examined in . . .. . . - . 11 cases. 

Normal in ... , 7 " 



Bache^ Patliologij of Cases of Telloic Fever. 



127 



Tinged vellow in . . . . ; 

Injected in . . . . . . 

" in spots in .... 

Effusion of yellow or oranfre-brown fluid in 
" blood with clot in 
" dark greenish brown fluid in 

The Heart was examined in . . . . , 

Tissue normal in . 
Right caritY distended with blood in 

" containing a clot in 

Left cavitj distended with blood in 

" cuutaining a clot in 
Large in ...... 

Small in ...... 

Pale in 

Black ecchymoses at base in . 

The Aorta was examined in 

Lining membrane yellow of different shades in 
buff in .... 
" red of different shades in 

The Piilmonarif Artery was noted in . 
Lining memljrane pale-yellO^\• in . 

vellowrsh-pink in 
buff in . . . . 

The Stomach was noted in 

Peritoneal covering congested in . 

" " ecchymosed in 

Contained black fluid and gas in . 

" dark coffee fluid in . . . 
" deep chocolate in . 
" thick dark-green fluid in 
IMiicous membrane slate-coloured in . . 

dark-green in . 
" softened in ... 

" corrugated in . . 

" " " uniformly red in 
yellowish-red in 
" spotted red in . 

" . . '• . black in 

" " brown in 

" mottled yellow, green, and slate in 

/" vrith linear depressions like ulcerati 

" of cardiac extremity red in 

" " smooth and 

red in 
ulcerated 

" " ecchymosed in 

*' " " brownish-green 

" • " slate-coloured 

" • " softened in 
" of pyloric extremity red in 

" ** " slate-cfdoured 

" " " rough in 

" of greater curvature red in 

" " ecchymosed in 

" of lesser curvature red in 

" '* spotted red in 



tted 



1 case. 
3 cases. 
1 case. 
9 cases. 
1 case. 
1 



3 " 

1 case. 

2 case- 
1 case. 



4 cases. 
1 case. 

1 " 

2 cases. 

14 cT^es. 

3 " 

1 case. 
7 cases. 
1 case. 

5 cases. 
1 case. 

3 cases. 

1 case. 

2 cases. 

2 " 
4 

1 case. 
1 

4 cases. 
1 case. 
1 •• 

3 cases. 



1 case. 
1 

1 " 
1 

1 

2 case's. 
1 case. 
1 

1 
1 
1 

1 " 



128 Bache, Pathology of Cases of Yellow Fever. [July 

The (Esophagus was noted in 9 cases. 

Mucous membrane injected in 4 " 

" slate-coloured in 1 case. 

" spotted red in 2 cases. 

" softened in 1 case. 

" spotted and striped black in . . .2 cases. 

*' partially denuded of epithelium in . . 9 " 

*' sphacelated in 1 case. 

The Liver was noted in 14 cases. 

Size normal in 12 " 

" small in .......... 1 case. 

" large in 1 " 

Consistence normal in . . . . . . . .13 cases. 

" soft in ........ 1 case. 

External surface yellow of various shades in ... 2 cases. 

" " and bronzed in .... 2 " 

" " with ecchymosed spots in . . 1 case. 

" mottled yellow and red in . . . .7 cases. 

*' " brown in . . .1 case. 

" *' purple in . . . 1 *' 

Superior surface pale-yellow in 1 " 

" yellowish-green in . . . . . 1 " 

" mottled yellow and red in . . . .2 cases. 

Inferior surface bronzed in 2 " 

" at anterior portion bronzed in . . . 2 " 

*' at posterior portion yellow in . . .1 case. 

" orange-red in . . 1 " 

Right lobe, superior surface, spots of ecchymosis in . . 1 " 
" striped green in , . . . 1 " 

" inferior surface, greenish-brown in . . . 1 " 
*' orange-red and green in . . 1 " 

Internal tissue gamboge-coloured in . . . . . 1 " 

" mottled yellow and orange-red in . . .12 cases. 

" pale-yellow in 1 case. 

Hepatic vein congested in 2 cases. 

" not congested in 2 " 

Portal vein congested in 3 " 

" not congested in . . ... . . . 2 " 

Large hepatic duct contained bile in 2 " 

Microscope showed oil in cells in 14 " 

The Gall-Uadder was noted in 12 cases. 

Contained bile of various shades in 11 " 

Empty in 1 case. 

The Small Iniestine was noted in 12 cases. 

Contracted in ......... 1 case. 

External surface yellow in . 1 " 

" very dark in 1 *' 

Contained black fluid in 1 " 

" gas and slate-coloured fluid in .... 4 cases. 
Mucous membrane reddened in . . . . ■ . . 3 " 

" yellow in 1 case. 

" slate-coloured in 3 cases. 

" not softened in 12 " 

" having ecchymoses in . . . . 3 " 

" mottled red and slate-colour in . . 1 case. 

" of duodenum reddened in ... 2 cases. 

" of dark purple-red in .... 1 case. 

" at ileo-c£ecal valve red in . . . . 1 " 
Peyer's patches unusually distinct in 1 " 



1854.] Jameson^ Case of Fistula. 129 

The Large Intestine was noted in . . . . . .11 cases. 

External surface very dark in 1 case. 

Contracted in . . . 1 " 

Contained gas and slate-coloured fluid in . . . .3 cases. 

" black tarry matter in 1 case. 

" slimy pink matter in 1 " 

Mucous membrane reddened in 2 cases. 

" reddened "in spots in .... lease. 

" slate-coloured in 3 cases. 

" not softened in 12 " 

*' near ileo-ceecal valve ecchymosed in . 1 case. 

" at sigmoid flexure had a patch of fibrin in 1 " 

The Spleen was noted in 10 cases. 

Normal in 6 " 

Hardened in . . . . . . . . . .1 case. 

Enlarged and hardened in 1 " 

" softened in .2 cases. 

The Kidneys were noted in 13 cases. 

Normal in . . . . . . . . . . 4 " 

Pale-yellow in .......... 4 " 

Yellowish-red in 1 case. 

Congested in 3 cases. 

Enlarged in . . . ... . . . . .1 case. 

The Bladder was noted in 6 cases. 

Contained urine in 4 " 

Empty in 2 *' 



Art. YI. — Case of very extensive Fistula, succesa/uJIy treated hy a New 
Method. By Horatio G-. Jameson, Sen., M. D., formerly of Baltimore, 
Maryland, now of Philadelphia. 

A GENTLEMAN of Princc's County, Maryland, was afflicted with a fistulous 
opening, which had been discharging freely for several years. Surgeon G. S. 
Pattison was sent for, and attempted to cure the case by laying open the sinus 
freely. An incision was made about thirteen inches in length, and four in 
depth, where it passed through the gluteal muscles. Some arteries were tied, 
and the wound dressed by putting in what sponges had been thought neces- 
sary for the purpose \ but such was the extent of the wound, that sis nap- 
kins were added to the sponges to fill it. 

The next morning hemorrhage occurred, and it became necessary to remove 
the dressings ; some more arteries were tied, but a vast deal of blood was lost, 
so that the patient was pulseless, or nearly so, for twenty-four hours, though 
plied freely with wine, brand}-, and whatever it was thought would tend to 
stimulate and sustain. His life, it was supposed, was, so to speak, for seve- 
ral hours suspended on a hair. Judging by the cicatrix, I have never seen a 
wound of such extent, either from casualty or the surgeon's knife, but was 
thereby forcibly reminded of the bold and successful operation by John Bell, 
for tying a wounded artery at the ischiatic notch. Several weeks served to 
heal the wound made to cure the fistula, but the gentleman was now greatly 
disappointed to find his case in no degree improved. 

His health reasonably restored, he put himself under my care in Baltimore. 



130 



Jameson^ Case of Fistula. 



[July 



Inquiring into the history of the case, Mr. S. informed me that he had no 
disease about the rectum or anus for many years ; but that, about sixteen 
years previously, there had been an affection of those parts; but he was not 
at all aware, at that time, of anything amiss except in his thigh. By exami- 
nation of the rectum, I soon found a sensible depression at a point directly 
opposite to the upper end of the sinus outside. It was firm and glossy to 
the touch, and would have held about the half of a musket-ball. In this 
depository, a passage had been formed for the matter to escape to the thigh. 
The true nature of the case is ascertained, but where is the remedy? John 
Bell's operation, two feet long, and down to the ischiatic notch, will not 
answer, for the head of the sinus is inside. I had seen that, if sinuses are 
laid o^en, they would heal — then, why? Because their surface is broken up, 
and an inflammatory action set up, which led to adhesion, and adhesion was 
the cure. So here; I hoped that, if I could by an}^ means abrade the sur- 
face, and excite a low degree of inflammation, I might hope to cure. But, 
here is a sinus ten or eleven inches in length, turning oS" nearly at a right 
angle, deep down among firm parts, and having to rise somewhat up into 
the pelvis. 

With a view of fulfilling these indications, I procured a steel probe of spring 
temper, of the proper length, and furnished with a button point, and an eye 
at the other end for carrying a thread ; from the point it was gradually taper- 
ing, so that it would bend most easily for the space of more than an inch ] this 
probe-was armed with a strong flax thread. The surfcice of the sinus being 
callous, I depended upon the blunt point keeping in the canal, while pressure 
at the lower end of the probe would cause it to bend where it was weaker 
than the other part of it. It may seem strange to say that I spent nearly an 
hour in accomplishing my purpose; eventually the probe entered the rectum, 
and now all was safe. A strong thread being tied to the eye of the probe, 
the latter was drawn out at the rectum, and the thread drawn through the 
sinus and rectum. 

A strong thread was now armed with small shot, the way boys put sinkers 
on their fishino-. lines; the thread was strunn; with the shot at the distance of 
three-fourths of an inch. The reader is no doubt aware that these shot.'being 
slit open to receive the line, and then closed in again so as to fasten the line, 
become very rough. This shotted line being tied to the first, was now drawn 
in by drawing the other out at the anus. It produced some irritation and 
slight inflammation, but not much pain; free suppuration soon took place. 
The patient was restricted in diet, and took some light physic. Perceiving 
that the shot, after some weeks, v/ere becoming tighter in the sinus, and the 
gentleman being anxious to go home, I provided a gold wire, which, being 
attached to the shotted line, was drawn in as the other was drawn out. In a 
few months there was a perfect cure without any confinement or suffering, 
and without any remedy except the wire, which, being of gold, there was no 
fear of its rusting or breaking; and the two ends being tied on the thigh at 
the lower end of the sinus, the patient could attend to his ordinary business 
without hinderance. 

A girl, about ten years of age, of scrofulous habit, was put under my care 
for a fistulous affection of the thigh, a little above the middle; it discharged 
freely, was painful, causing great lameness. The usual remedies were used 
for the constitutional symptoms, and various injections made use of for some 
months with but little benefit. I had recourse to an iron spring, made by 
flattening the vv-ire, and leaving the edges rough as they came from the ham- 
mer. The sinurf was about six inches in length, and the spring suited to the 



1854.] Fenner, Cases of False Anchylosis of the Lower Jaw. 131 



sore, but allowing room to push the head of the spring into the orifice of the 
sinus; and it was provided with a short string, by which the spring could at 
any time be removed. This is necessary once in two or three weeks whenever 
iron is used, lest it rust, and break off in the canal. The spring must be so 
graduated, as to the size of the wire, -as that it shall have strength to keep 
straight, and press slightly against the sides of the sinus, but not so as to cut 
in and cause pain ; for this case/ the wire used was perhaps one size larger 
than what is called bonnet-wire — this is the form of it : — - 




I have seen an unfortunate woman, who was operated on for fistula in pe- 
riueo, wherein the partition between the vagina and rectum was split open, 
and so it ever remained for many years. Soon after I had seen this case, a 
case presented itself in a respectable poor woman, who attended market for a 
living. It gave her much pain, with annoying discharges, which admitted 
hardl}^ a possibility of cleanliness. Long walks, and heavy loads, were her 
daily task. The usual operation could only have been efi'ected by her laying 
up in some charitable institution, and a confinement of several weeks. I 
adopted the method by the iron spring. The spring was introduced and 
worn about four months, wheti, being withdrawn, she was found to be entirely 
freed from the disease, and sound and healthy in the parts. She never lost 
a day, never made a complaint, walked with loads, and stood long at her 
stall; never took a dose of medicine. The spring was cleaned once in three 
or four weeks. I weighed one of the springs, it weighed between nine and 
ten grains. We have heard of iron being much more valuable than gold in 
the ibrra of hair-springs for watches, but if ten grains of wire can be made to 
cure troublesome and dangerous fistulse, what price shall we set upon it ? 
'J hese are. only specimens of what has been done, and what I hope may yet 
follow. These are made by flattening what is called thread wire with the 
hammer; we must not make the head too large, so that we can push the head 
through the orifice of the sinus. They should have heads of clifferent sizes, 
to suit the size of the orifice. We have cured, by this means, fistulas in 
other parts of the body — fistula in ano among them. 



Art. til — Cases of False Anchi/hsis of the Lower Jaw. 
By C. S. Fenner, M. D., of Memphis, Tenn. 

Case I. — Thomas Frank, a young man eighteen years of age, came to me 
in July, 1851, with false anchylosis of the lower jaw; the result of extensive 
sloughing, caused by salivation six years previously. On an examination, I 
found the jaws so completely closed that a thin knife-blade would not pass 
between the teeth ; and no force that we could apply produced the slightest 
depression of the inferior maxillary. There was a very slight lateral motion, 
just sufiicient to be perceptible, from which I inferred there was no osseous 
deposit about the joint. The condyles of the inferior maxillary bone rested in 
the anterior portion of the glenoid cavity, causing the inferior incisors to project 
beyond those of the upper jaw, leaving a small space through which he passed 



132 



Fennerj Cases of False Ancliylosis of the Loicer Jav:. 



[July 



Lis food. On the left side, a firm cartilaginous substance commenced just within 
the angle of the mouth, extending backwards, occupied the entire place of the 
masseter muscle; involving the gums and mucous membrane, and embracing the 
teeth so firmly that a probe would not pass backwards. He had previously sub- 
mitted to two operations with the knife, but without benefit from either. He 
had also been subjected to the long-continued action of the screw, without 
any satisfactory result. I thought he could be relieved by an operation, and 
advised him accordingly. He was willing to submit to anything that pro- 
mised the least prospect of success, and expressed a wish to die under the 
operation, if it should fail to relieve him from his truly pitiable condition. I 
prepared myself for the operation after the manner recommended by Dr. Mott, 
and others, to use a large amount of force to separate the jaws after the liga- 
mentous bands had been freely divided with the knife. The patient was 
placed in a recumbent position, and chloroform administered. I then placed 
a scalpel (having been previously wrapped to within an inch of the point to 
avoid cutting the angle of the mouth), w^ith the back resting against the 
teeth, and pushed it backwards to a point about an inch above the angle of 
the jaw, continuing the incision as the knife was withdrawn, until the fibro- 
cartilaginous ligament was completely divided. The finger now easily passed 
back to the ramus of the jaw. The knife was laid aside, and as much force 
applied, to depress the jaw, as we thought the bone capable of sustaining; 
but without effect. Upon further examination, this same ligamentous forma- 
tion was found to occupy all the space back of the alveolar processes, and 
between the coronoid process and pterygoid process of the sphenoid bone ; 
still forming a powerful bond of union to keep the jaws together. I deter- 
mined to divide this. The point of the scalpel was placed immediately back 
of the last molar, with its edge looking upward and backwards ; the flat sur- 
face rested against the anterior edge of the coronoid process, and pushed it 
forwards to the pterygoid process, carrying the incision upwards along the 
neck of the bone. With the left hand placed on the chin, the jaw was felt 
to yield at each stroke of the knife, until the separation was complete. This 
was accomplished without the application of any more force than the simple 
weight of the hand resting on the chin. 

The last part of the operation was attended with some difficulty, owing to 
its being necessary to keep the patient's mouth in a dependent position, to 
allow the escape of blood, which also obscured the parts from view ; and 
before the jaws were separated it was difficult to use the finger of the left 
hand as a director for the knife. A wedge-shaped piece of cork was now 
placed between the teeth to keep the jaws apart^ and the operation was com- 
pleted, proving entirely successful. 

Case II. — Miss Eobinson, eleven years of age, had been similarly afflicted 
for two years, from the same cause, the disease occupying the same side as 
in the above-described case ; but here the lower incisors closed behind those 
of the upper jaw. This case was operated on in the same- manner as described 
above. During the latter stage of the operation, the jaws separated at each 
incision of the scalpel, until they opened sufficiently wide for all useful pur- 
poses. After two or three weeks there was a strong tendency to contractions 
of the divided parts to their original position. This, however, was entirely 
overcome by perseverance, using the jaws freely in mastication, and keeping 
them for a considerable time widely separated by substances forced between 
the teeth. A thick piece of caoutchouc, doubled on itself and placed between 
the molar teeth, was found to accomplish this object admirably, without 
fati^^uinf^ the muscles. 



1854.] 



Shanksj Case of Hijdromelra. 



183 



Remarks. — In all the successful operations for false anchylosis of the lower 
jaw that I have seen reported, great force has been applied to separate the 
jaws after the knife has been laid aside. In Dr. Mott's case, reported in this 
Journal for Nov. 1829, p. 102, the screw was brought to bear on the parts, 
and a report followed like the " laceration of ligaments this was undoubt- 
edly caused by the tearing asunder of the cartilaginous bond of union imme- 
diately back of the alveolar processes. That there was no bony deposition, is 
evident from the fact that slight lateral motion existed. Similar motion could 
be produced in both of the cases I have described, and the freedom with 
which the patients could use the parts immediately after the operation, shows 
there could have been no bony deposit about the joint. 

In the only case of true anchylosis of the lower jaw I have met with, the 
jaws were slightly separated, but no motion whatever could be produced in 
any direction, although no unnatural ligamentous bands existed. Dr. Sims, 
several years since, reported in The New Orleans Medical Journal, a case 
similar to those I have above described, in which he succeeded in separating 
the jaws after his incisions were made, by means of levers of wood introduced 
between the teeth. I believe^that, in both Drs. Mott and Sims's cases, suc- 
cess would have been much more easily attained, and equally as satisfactory, 
had they completed their operations with the knife alone. It is certainly 
easier, and much less painful to the patient, to divide a firm cartilaginous 
bond of union with a sharp knife, than to tear it asunder by the application 
of powerful force. Cases frequently occur, in which the cicatrix does not 
extend back as far as the coronoid process. I operated, in November last, 
on a young man, for immobility of the lower jaw, where the false ligament 
occupied both sides, but in neither did it reach further back than the second 
molar tooth. I divided the cicatrixes on both sides, and free motion of the 
jaw followed. The operation in such cases is much more simple than it is 
when the parts are involved back of the alveolar processes. 



Art. YIII. — A Case of Ri/drometra. By Lewis Shanks, M. D., Professor 
of Obstetrics, in the Memphis Medical College. 

The subject of this case, Mrs. W., was about fifty- three years of age, san- 
guineous temperament, tall and rather slender, of more than ordinary intelli- 
gence and physical energy; she had given birth to, and raised, ten children. The 
youngest was born in 1811, twelve years since; soon after which she lost her 
husband, and remained a widow six or seven years. She has been married 
to her present husband five or six years. Menstruation ceased at the age of 
forty-seven or forty-eight, about five years since. Previous to, and for three 
years after the cessation of her menstrual periods, her health was good. 

She was attacked two years ago with an acute bowel affection of a dysen- 



134 



Shanks, Case of Hydrometra. 



[July 



teric character, which became chronic and protracted, and, as she supposed, 
originated uterine disease. 

The first symptoms of the disease of the uterus supervened upon the chronic 
dysentery, and consisted of a tumour in the lower part of the abdomen. 

This uterine tumour, though somewhat sensitive upon pressure, did not 
produce for months, much inconvenience, either from its size or tenderness. 
Twelve months since, however, she was induced to consult her medical at- 
tendant, and subsequently several physicians. Different opinions having 
been expressed to her, as to the organs involved, and their true pathological 
state, and the enlargement of the abdomen having increased so much as to 
make her condition very uncomfortable, she came to the city for the purpose 
of consulting, and putting herself under the treatment, of Dr. Fruyser and 
myself. 

Upon a careful examination of her condition, and the history of her case, 
we were satisfied that the great enlargement of the abdomen was produced by 
the expanded uterus, and that the large amount of fluid in the uterus was 
contained either in its proper cavity — the internal opening of the cervix being 
occluded — or in a large intra-uterine cyst, which expanded the organ. This 
diagnosis was made from the very distinct abdominal fluctuation produced by 
palpation, and from the expanded condition of the cervix and lower segment 
of the uterus, ascertained by the vaginal and rectal examination. Though 
the enlarged and expanded state of the lower portion of the uterus was cer- 
tainly ascertained to constitute the lower portion of the great tumour which 
filled the abdomen; there was so much hypertrophy and induration of this 
portion of the uterine walls, that no distinct fluctuation at the point of vaginal 
touch could be produced by abdominal palpation. The os was low down in 
the pelvis, and could readily be reached, above the posterior commissure of 
the vulva; and though the walls of the cervix were abruptly expanded and 
greatly consolidated, the first phalanx of the index finger could readily be in- 
troduced into the os. 

Having made this diagnosis of the case, it was decided that the occluded 
cervix, or the cyst within the cavity of the womb, should be opened the next 
day, and the contained fluid drawn off, as there was danger, from the great 
distension of the abdomen, of a rupture of the womb. There was no ulcer- 
ation of the ps, no ichorous or offensive discharge, indicating either concealed 
ulceration or malignant disease, though the induration and thickening of the 
walls of the cervix were unusually great, and, to the touch, of almost cartila- 
ginous hardness. 

Fiibruary 6, 1854. After an unsuccessful effort to introduce a common-sized 
metallic bougie, and different-sized catheters, I resorted to the common-sized 
uterine porte-caustique. After bending the end of the staff, which projected 
an inch and a half through the canula, so as to enable me to push it upwards 
and forwards behind the pubes, in the direction of the axis of the cervix, and 
toward the centre of the tumour; I succeeded, by using a moderate degree 
of force, in passing it two inches into the cervix; then meeting with elastic 
resistance, produced by the cyst, I forced th*e point of the staff in the direc- 
tion of the centre of the tumour, through the cyst into its cavity; the canula 
was then pushed into the cavity of the cyst, and the staff withdrawn. 

Two ounces of a thick and gelatinous fluid, of a brownish colour, like 
honey, were evacuated. The staff was again introduced through the canula, 
and pushed into the large cyst, when eighteen pints of sero-sanguinolent 
fluid were drawn off without further difiiculty. 

The hypertrophied walls of the cervix were so consolidated as to nearly 



1854.] 



Shanks, Case of Ili/drometra. 



135 



close the opening or channel through the neck, and to embrace firmly the 
canula, though not larger than a small- sized catheter. This narrow channel 
from the os, through the cervix to the cavity, was two inches or more,' and 
clasped the canula so tight as to require some force for its withdrawal ; and 
the density of the cyst was rendered obvious by the very perceptible jerk pro- 
duced by its walls slipping over the end of the canula when it was withdrawn. 

After the water was discharged, sthe hypertrophied and indurated state of 
the neck and lower segment of the body of the uterus was more manifest and 
better defined. The general structure of the uterus was soft and flabby, and 
remained uncontracted ; but the thickened and indurated neck and lower seg- 
ment of the body projected up on the sides in the iliac fossa, so as to form on 
the lateral uterine walls, a distinct circular ridge, like the sides of a bowl. 
This indurated portion of the womb was attached by adhesive inflammation to 
the pubes and other surrounding parts, so as to fix the womb firmly in its 
position. The chief pain and soi-eness, during the progress of the disease, and 
at the time of the operation, was in this indurated portion and the surround- 
ing tissues to which it was attached. For several weeks before the operation, 
the great distension of the womb and enlargement of the abdomen, not only 
made her constantly uncomfortable, but disqualified her from turning in bed, 
without raising hferself up so as to prevent the dragging and pain produced 
by it in the lower portion of the tumour and its surrounding parts. 

After the womb was evacuated she was much more comfortable, and con- 
tinued so until the fluid accumulated again. Though quietude, laxatives, and 
alteratives were instituted to prevent inflammation, and the accumulation of 
the fluid, in a month she was again so much enlarged as to require another 
operation.' 

On the 7th of March, I drew off, in the same way as by the first operation, 
fourteen pints of fluid. Though not so large as before, her stomach and 
general health were more impaired. The fluid presented more the appearance 
of an admixture of pus and mucus, or albuminous matter with the serum, 
being thicker and more tenacious. When the ey.st was evacuated, I injected 
througli the canula about 20 oz. of water, with Ji'j of tr. of iodine added to 
it. This was agitated in the sac a few minutes and then withdrawn . 

As a general course of treatment, she was then directed to wear a tight 
flannel abdominal bandage, twice a day to paint the hypogastric and iliac 
regions with the tr. of iodine; to take at bedtime, as an alterative and tonic, 
a pill containing proto-iod. hydrarg., extr. colocynth. comp., extr. cinchon., 
each, a grain, and 8 drops of syr. ferri iod., three times a day. Under this 
course her general health improved, and the fluid accumulated much slower. 

April Six weeks since the last operation; she came in her carriage 
from her home, about twenty miles, to the city. Though the womb was 
very much distended again, her general health was much better. Being 
desirous to try the effect of Bailey's Spring, near Tuscumbia, Ala., a water of 
much celebrity in dropsical cases; to prepare her for- her journey, and for the 
more favourable action of the medicinal water, I drew off eighteen pints of 
fluid again on the 17th of April. It presented less appearance of the admix- 
ture of pus, or mucus with the serum, than at any previous operation. I 
injected again about ^xx of water with of tr. of iod. This produced a 
slight difl'used sensation of burning in the cavity of the sac, which soon passed 
off, and she felt very comfortable after it. 

The second and third operations indicated less consolidation and contraction 
in the cervix, but the dense membranous cyst was more obvious and resisting 



136 



Shanks, Case of Hydrometra. 



[July 



to the blunt end of the porte-caustique staff, requiring considerable force to 
puncture it and penetrate the cavity. 

She continued comfortable after the third operation, and in three days 
started on a boat to Bailey's Spring. The journey to be made by water, 
except ten miles from Tuscumbia, 

Since her departure from here on the 19th of April, three days after the 
operation, I have not heard from her. 

Remarh?,. — I have described this case somewhat in detail, as no case of 
hydrometra so well marked has been reported, within my knowledge, in this 
country. Its existence, indeed, being more than doubted by Prof. Meigs, in 
his works on obstetrics and the diseases of females, in which he says, " as to 
hydrometra, I do not believe in it. It is indifferent to me who has seen it, 
or who has heard of it. I repeat, I do not believe in such a malady." To 
prove the disease does not exist, he says : To have a true dropsy of the 
womb, you must imagine the os uteri hermetically sealed, and the cavity of 
the organ filled and distended with serum." 

How near the description of this case, the quantity of serum contained in 
the cavity of the womb, and the difficulty of drawing it off through the con- 
solidated neck, with its cavity contracted, and its internal opening perfectly 
occluded, comes to what Dr. Meigs describes as being necessary to constitute 
hydrometra, the reader must judge. 

The result of this case, time only can determine. The long and narrow 
channel in the neck rendered it impracticable to introduce an instrument 
sufficiently large to make a free incision in the dense membranous sac which 
contained the fluid, so as to keep it open, and thus discharge the accumu- 
lating serum, and prevent the inconvenience and pain produced by the great 
distension of the womb. 



1854.] 



137 



REVIEWS. 

Art. IX. — Human Ovulation and Menstruation. (Beitrage zur Lehre 
von der Menstruation und Befruchtung.) Prof. Dr. Th. L. W. Bischoff. 
In Henle and Pfeufer's Zeitschrift fiir rationelle Medicin, lY. (N. S.) Hft. 
i. pp. 129-175. 1853. 

This recent contribution to Human Generation, by one who stands pro- 
minent as an investigator of that difficult department of physiology, and whose 
researches have contributed so largely to its elucidation, is well worthy of an 
attentive consideration. We improve the opportunity for some extended 
remarks on this subject, in the shape of a somewhat discursive review. 

Human physiology has always laboured under the disadvantage that its 
students have been inclined to isolate man from the rest of zoological creation, 
as much in his physical as in his moral capacities and relations. There seems 
to have been a tacit assumption pervading all their inquiries that the human 
species, in virtue of its high prerogative morally, is likewise removed, as to 
the laws governing its physiological conditions, from the rest of mammalia. 
It is true that the influences of artificial modes of life, as introduced by ad- 
vancing civilization, have so masked the naturalness of many of his functions 
as to apparently favour this view; but viewed from a normal healthy point, 
man's physiological conditions hang upon the same general laws, in the strictest 
sense of the terms, as those of the great order to which he belongs. He has, 
it is true, degenerated so much physically that his pathology almost exceeds 
his physiology, and, therefore, there is so much the more need that we use as 
stand-points general principles, in our examination of the conditions of par- 
ticular functions. 

As might be supposed, in no department has this error been more prominent 
than in everything relating to the subject of human generation. Aside from 
the intrinsic difficulties of the subject itself, there is another reason why this 
construction should be put upon it: this is that, in civilized nations, no class of 
functions have been so perverted as those relating to reproduction. These per- 
versions, these anomalies, combined with the fact that the nature of the case 
has obliged us to receive testimony, as to facts, from persons incompetent to 
observe, have very naturally led to the general opinion that, in as far as relates 
to this department, man stands aloof from the other mammalia. I refer here 
particularly to ovulation and impregnation. 

Even from the days of Aristotle, the leading physiologists of every age have 
alluded to or even predicated the more or less complete uniformity of these 
functions in man with the animals beneath him; but a demonstration of this 
important point, based upon the careful observation of facts, belongs to very 
modern times. 

Baer, BischoflF, and Pouchet take this merit almost wholly to themselves, 
although others have followed in their line of inquiry, and furnished valuable 
results. 

Confining our attention to ovulation, menstruation, and impregnation, we 
may say that these more modern researches have shown that, in the human 



138 



Reviews. 



[July 



female, tbe menstruation corresponds pbjsiologicallj to the periodical heat or 
rutting time of other mammalia; that at each menstrual period, in the healthy 
state, an egg is discharged from the ovaries, received into the oviducts or Fal- 
lopian tubes, and there is ready for impregnation; that the evidence of this 
discharge of an ovum from the ovary, is the formation of a corpus luteum", so 
called, in the tissue of the ovary ([ omit here any allusion to the relations of 
the verum and spurium?)) that impregnation, therefore, should m the normal 
state be possible only when coincident with these last-mentioned conditions, 
and impossible at intervening periods. 

These are the prominent points, more or less distinctly made out by the 
difficult and oft-repeated experiments and observations of modern inquirers. 
That menstruation is not a function sui (jeneris and peculiar to man, in its 
physiological signification, and that an egg is, in the normal state, discharged 
at every menstrual period — these two points stand well determined; but the 
others, the relations of the corpora lutea, and the possible period of impreg- 
nation, are far less satisfactorily positive; the first, from difference of opinion 
on the same data; the second, because the contingencies depending directly or 
indirectly upon the artificial mode of life of man form almost always a barrier 
to the truly normal discharge of the function. 

The present paper of Bischoff is the more interesting and impT)rtant, as 
bearing quite directly upou these last two points; and we will now analyze its 
contents. 

This paper was based upon the observation of thirteen cases, which he had 
had the opportunity to examine during a period of many years. The exami- 
nations were made with the characteristic care of this investigator. After 
alluding to the difficulties attendant upon this class of observations, especially 
in the human species, such as those necessarily intrinsic to the nature of the 
case and subject; the usually great length of time after death that examina- 
tions can only be made; the difficulty of examining oviducts and ovaries, from 
partial decomposition; the liability of the egg to disappear, or not to be found, 
from its extreme tenuity, &c., he proceeds with the details of the caseSj of 
which we give the following synopsis: — ^ 

Observation I. Person, set. 20. Died during menstruation. Had borne 
a child in former years. Uterus was found filled with blood, and the ovaries 
contained numerous highly developed Graafian follicles, and several corpora 
lutea in different stages of retrogression ; but one of these last appeared recent, 
and was filled with blood. No egg and no spermatic particles were anywhere 
found, upon the most careful search. The inner uterine surface presented 
some changes, having a velvety aspect, and a more or less development of the 
uterine glands. 

Observation IT. Person of unknown life, who had drowned herself. 
Eight ovary contained a very large Graafian follicle, inclosing a distinct egg. 
No appearances of existing menstruation, but rather those indicating that it 
was about to occur, such as the villous development of the uterine surface. 

Observation III. Person oet. 21, who had drowned herself. Had had no 
children. The period of menstruation had probably just passed. The left 
ovary contained a very distinct corpus luteum, and the right ovary a ruptured 
Graafian follicle filled with fresh blood ; the wails of this last were already 

' In consequence of the general manner with which we can here discuss tliis subject, 
we omit the numerous measurements of the size of the dilfcrent parts of tlie intcrnai 
genitalia, Avhich Bischoff has given in many of his cases with the greatest care. 



1854.] 



BiscbofF, Human OiuJalion and Menstruation. 



139 



thickened, and the first stages of the formation of a corpus liiteum indicated. 
Uterine surflice somewhat changed, but no appearance of villi or developed 
glands. No egg found in the right oviduct, or in the uterus. 

Observations IY. and V. The internal genitalia of two young persons 
received for examination. Death from acute disease during menstruation. 
The right ovary of each showed a freshly ruptured Graafian follicle, filled with 
a blood coagulum. Inner surface of uterus presented no marked development, 
no prominence of uterine glands, and no beginning of a decidual formation. The 
oviduct and uterus were searched in vain for an ovum, in both cases; neither 
were any spermatic particles found. 

Observation YI. This case was related in MiiUer's Arch., 1846, p. 111. 
The uterine surface presented a considerably far advanced formation of a de- 
eidua by the highly developed uterine glands ; a recent corpus luteum had 
begun to be well formed, but, notwithstanding, no egg was found. Bischoff 
thinks that, three weeks having elapsed since the last menstruation which was 
coincident with a coitus, pregnancy had commenced. 

Observation YIL Person set. 19. Suicide by drowning, three weeks 
after marriage. Right ovary contained a recently ruptured Graafian follicle, 
inclosing a more or less altered coagulum. The inner surface of uterus was 
highly developed, vascular, velvety, and indicating the decidual formation ; 
although, from progressing decomposition, the uterine glands were not dis- 
tinct. No egg or sp'ermatic particles found in oviduct or uterus. 

Observation YIII. Person childless; ast. 19. Suicide by hanging. 
Eighteen days before death, menses, as usual^ of four days^ duration. Coitus 
coincident. 

Right ovary contained a very large corpus luteum, and both ovaries had 
marks of old but spurious corpora lutea, also numerous Graafian follicles. 
Uterine mucous membrane considerably developed, and two to three lines in 
thickness; uterine glands also prominent. No egg found in oviduct or uterus; 
but close to the insertion of the right oviduct upon the uterus, there was a 
peculiar formation in the mucous membrane, composed of fusiform cells and 
granules, which resembled remarkably a nest. But in this Bischoff could find 
nothing resembling an egg; it may be, however, that this structure served as 
a lodging-place for the egg during its first development in the uterus. 

Observation IX. Maiden, get. 19. Died of acute disease two days after 
a menstruation of three days' duration. Right ovary contained a pretty large 
projecting Graafian follicle, which was still closed, but filled with coagulated 
blood. Both ovaries contained very small corpora lutea. Uterine mucous 
membrane presented no marked development; uterine glands not distinct. 
No egs waS: found in the oviduct or the uterus. 

Observation X. Person ast. 20. Suicide by drowning. Menses known 
to have appeared ten days before death. Genitalia, and especially uterus, 
largely developed, and bore marks of a previous pregnancy. Right ovary 
contained a recently ruptured Graafian follicle, which, however, formed no pro- 
jection on the ovary, but rather a dark red spot on its surface. Here, also, 
out of five irregular lobules, a fresh corpus luteum could be made out, filled 
with dark coagulated blood, and containing a cavity surrounded by a denticu- 
lated yellow mass. 

Uterine surface changed, soft, velvety, and highly reddened. Uterine 
glands developed and quite distinct. No egg found in oviduct or uterus, and 
no spermatic particles. 



140 



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[July 



The prominent development of the corpus luteum, and of the uterine 
mucous membrane, renders it highly probable that pregnancy, depending 
upon the last menstrual period, had commenced. 

Observation XL Person childless, young, but age unknown. Suicide 
by drowning. Imperfect menses ten days before death. Coitus coincident, 
lloth ovaries contained the remains of many spurious corpora lutea, as also 
numerous transparent Graafian follicles. Right ovary contained a very large 
Graafian follicle unopened, but inclosing a brownish, chocolate-coloured 
matter, evidently altered blood. The walls of the follicle were not thickened, 
and there were no appearances of a forming corpus luteum. Uterus contained 
no blood, and its mucous membrane was scarcely changed. Here, also, no 
egg or spermatic particles were found after the most careful search. 

in this case the imperfect menstruation, the want of development of uterine 
surface, the appearance of Graafian follicle, indicate that probably there was 
no real escape of an egg, but simply an effusion into the follicle. 

Observation XII. Person childless, aet. 34. Death by epilepsy. Mepses 
of several days' duration seven days before death. Both ovaries presented the 
marks of old corpora lutea; the right ovary contained a recent corpus luteum. 
The inner surface of the uterus was not smeared with blood, and the mucous 
membrane was feebly developed. No egg, as usual, was found after diligent 
search. 

Observation XIII. Person a3t. 34. Suicide by han'ging. Menses four 
weeks, and coitus for several weeks, but lastly four days, before death. Right 
ovary showed a ruptured Graafian follicle containing no blood-coagulum, and 
w4iose walls were only corrugated, not thickened. Uterine surface villous, 
with glands developed, and the appearance of a decidual formation. As usual 
no egg, neither spermatic particles, could be found. The history of this case 
showed that the person was married, and, fourteen months before death, had 
borne her only child, which she had nursed until within three weeks, when 
milk failed. During lactation, menses had been regular. Here it is most 
probable that all the phenomena connected with menstruation were developed 
without pregnancy, rather than that this last had really taken place. 

These thirteen cases I regard as of high value in physiology. Our theories 
have always been good enough, but there has been a want of well-observed 
facts on this subject, especially in our own species. 

The results here obtained show that in the human female, at each men- 
struation, a Graafian follicle is ripened, swells, and usually bursts, discharging 
an egg, and forming a corpus luteum.^ This is the grand physiological stand- 
point from which radiate many inquiries and queries. The first query is, is 
there a rupture of a follicle, with a discharge of an egg, at each menstruation, 
without exception ? 

Goste has stated his opinion that menstruation may occur without such 
rupture, but this statement seems to have been made more upon hypothesis 

' It is not meant, of course, that this is the first time these doctrines have been put 
upon the substantial basis of observation, although the present cases are of great value 
in a confirmatory point of view. As early as 1842, Bischotf and Pouchet brought out 
these views in a more or less decisive manner, and since an occasional, though all the 
more precious contribution, has tended to a corroboration of these important doctrines. 
Among these last, see the excellent paper of Dalton, "On the Corpus Luteum of Men- 
struation and Pregnancy," a prize essay, in the Trans, of the Avier. Med. Assoc. vol. 
iv. 1851. 



1854.] 



Biscboff, Human Ovulation and Menstruation. 



141 



than observation.^ Observation XI. shows that the apj)arent pbenomcDa of 
menstruation, such as discharge of blood, &c., may be present without even 
the rupture of a matured Graafian follicle. When such is the case the female 
is sterile, although regular apparently in her menses. BischofF remarks that 
perhaps the dysraenorrhoea may be due to such imperfect development. Bis- 
choff thinks he has observed the same phenomena in the hog; the Graafian 
follicles seem well developed, but ,they do not burst, perhaps from an undue 
thickness of the walls, and blood is effused into their cavity. 

The maturation of the egg in the ovary is the essential point in the whole 
process of menstruation; the menstrual secretion is secondary and resultant. 
Normally, these different processes all concur exactly, and then conception is 
possible if there is a coincident presence of spermatic particles. But if all are 
Dot concurrent, conception cannot follow; such prominently are, where the egg 
is matured properly and in due time, but the Graafian follicle does not burst 
and allow its escape; and where it is matured and discharged formally, but 
there being no corresponding uterine changes, it does not meet a fit nidus in 
the uterus, and is therefore lost. From these considerations it is evident 
that there may occur menstruation in a subject without fertility, but as the 
maturation and discharge of the egg is the leading inducing physiological 
process in this compound function, it (that is, this last) can never occur with- 
out a menstruation of some kind. Medical literature of this department con- 
tains numerous cases which, i-f we could credit, would support almost any 
theory or view connected with the phenomena of menstruation and conception. 
But few of these statements are worthy of any reliance, whether they apparently 
support or not the true physiological view of the case as founded upon observed 
facts — for upon the whole subject of sexual relation, especially when in a per- 
verted state from physical disease, there seems to be with the patient a kind of 
moral obliquity which precludes a correct, truthful statement of his or her case, 
even where the physician or inquirer can see no possible reason for a suppres- 
sion of the whole truth. This is indeed a most singular fact, but its truth 
will be attested to by many a medical man who has more than once had his 
well-grounded phj^siological views on a sexual subject completely unsettled 
by statements of patients whose veracity and singleness of mind (on other 
matters at least) had long been well known. We think it may be stated, 
therefore, that in everything pertaining to perverted sexual conditions, facts 
observed by one's own senses must hold the importance of being objective, 
while the statements of the individuals themselves must be received only as 
subjective, 

Bischoff has related a case finely illustrative of this point, no less than of 
the sagacity of his mind and clearness of his knowledge on these subjects. 

But we will proceed. There can be no doubt from the results of the pre- 
ceding cases that, when a regular menstruation occurs in a healthy person, 
and of course preceded by a normal maturation and discharge of an egg, there 
is always a development of the uterine mucous surface, whether impregnation 
occurs or not. Thus, this would be the case in every well-developed healthy 
maiden. But this uterine development to receive the egg may be deficient 
from various causes, such as sickness, general weakness, local circumstances, 
&c. This leads to some interesting inquiries and suggestions. 

Thus absent or defective formation of this uterine mucous membrane is most 
probably a frequent cause of sterility, especially if all the ordinary observable 

" See Coste, Hist, dii Developpement, ^'c. i. p. 221, and Bischoff's notice thereof ia 
Schmidt's Jahrbuch, Ixix. p. 367, 1851. 

No. LV.— July 1854. 10 



142 



Reviews. 



[July 



conditions of menstruation are present. Kn egg is discharged normally, and 
may even be as regularly impregnated, but it meets no proper nidus in the 
uterus. Herein, also, Bischolf remarks, may perhaps be found the reason 
why so many women who have borne one or several children, suddenly cease 
to be fruitful, and remain so for many years, notwithstanding they continue to 
menstruate normally and there is no general apparent cause for this condition 
of things. In civilized life, and perhaps also in savage life where the conditions 
of generation are more or less normal, it is certain that the productiveness of 
the uterus ceases long before that of the ovaries. We may add that this is a 
topic of no small moment outside of the domain of scientific physiology. In 
the present high march of civilization — the continued introduction of artificial 
conditions of life — there is evidence of a sad degeneracy in this respect. 
Early marriages, before the uterine powers are fully matured ; the confinement, 
art, and excesses of a city life, even with a well-developed, robust constitution ; 
these may be mentioned as quite adequate to induce either a complete sterility 
at first, or at least after the first or second child. 

But there is another point in this connection of considerable physiological 
interest; it is, that it is very probable that the time of this uterine development 
necessary for conception, varies in different females, so that some may conceive 
a longer, and others a shorter time after menstruation ; perhaps also there is 
a like variation as to the coincidence of development between the egg and 
this uterine formation. The longest time this uterine development was ob- 
served after menstruation was eighteen days, as recorded in Observation VI 11.^ 
This point, however, has other relations, particularly the question of the 
inclusive possible period of impregnation in the female, which we propose to 
notice hereafter. 

In regard to the so often discussed question of the value of the corpus 
luteum, and its relations to conception and pregnancy, Bischoff has some 
valuable remarks which we notice more especially as indicating his real 
matured views on this subject.^ 

Bischoff declares that his extended observations have led him to the opinion 
that there is a real distinction between the corpus luteum of simple menstrua- 
tion and that of pregnancy ; in other words, there are corpora lutea vera and 
spuria.^ But the differences are not due to primary physiological relations, 

1 Dalton [loc. cit. Observations Y., YI.) has recorded two cases in which this de- 
cidual formation was observed, one fourteen, the other twenty-one days after men- 
struation. But it appears to have been subsiding, especially in the latter case. 

2 It is clear that Bischoff's views on this subject have not sometimes been correctly 
given, and we think it worth while to here allude to the matter. In a translation of one 
of Bischoff's Avritings there is the following passage : "Now, from all these observa- 
tions, it is quite certain that the ova in mammalia, in the time of health, no coition 
taking place, are detached from the ovary, enter the tube and perish there ; and that 
the corpora lutea are formed in the ovaries just as though coition and fecundation had 
taken place." See " On the Maturation and Discharge of Ova, independent of Coition," 
Oilman's and Telkampf's Translation, Ncav York, 1847, p. 45 ; quoted in Dalton, Joe. 
cit. p. 14. This translation does not distinctly convey the idea meant by Bischoff. 
Bischoff means that a corpus luteum is always formed when an ovum is normally dis- 
chai'ged, but does not refer to the question of true and false corpora lutea. 

3 It may be well to allude here to the views of those who have more or less recently 
given attention to the subject. First may be mentioned Pouchet {Theorie Positive de 
V Ovulation Spontanee et de la fecondation des Mammifh-es et de Vesplce Humaine, ^^c. ^c. 
Paris 1847), Avho, basing his opinion upon theoretical grounds rather than upon direct 
observation, declares that the distinction between the true and false corpora lutea is 
unfounded, (See p. 185.) 

This is also the viev\r of Eaciborski {De la Puberte et de I' Age critique, ^c. Paris, 
1844). But decidedly the work of the most importance in this connection, because 



1854.] Bisclioff; Human Ovulation and Menstruation. 



143 



for these are the same in both cases; they depend rather upon secondary con- 
ditions. In the normal menstruation, necessary to conception, an egg is dis- 
charged as we have seen, and the corpus luteum which is Jint found is pre- 
cisely the same, whether the egg be impregnated and pregnancy follow, or 
whether it pusses away unaltered. So much for the primary process. But 
here the parallelism ceases. If conception does not occur, the turgescence of 
the ovary incident upon the maturation and discharge of the egg quickly sub- 
sides, and the opposite state follows. The retrograde changes, therefore, in 
such a corpus luteum are rapid, absorption is constantly going on, and by the 
time of the succeeding menstrual period, the remains of the ruptured Grraafian 
follicle, with its eflfused blood, have been more or less removed, leaving behind 
only a few markings. This is the corpus luteum spurivm. 

On the other hand, if pregnancy does occur, the changes in the ovary above 
described are much less marked, the whole internal sexual apparatus being the 
seat of high vascular action. The consequence is, that the corpus luteum, in 
its full size, changes very slowly, and generally has diminished but little during 
the first month of pregnancy; and these alterations are so slow, that they often 
do not cease until after parturition. It will be readily perceived that a body 
thus formed will differ, in texture, compactness, colour, &c., from the former, 
which was subjected to the action of absorption. ''But what," asks Bischoff, 
''is the diagnostic value of this distinction, well-marked as it is at the time? 
During pregnancy it is, of course, of no worth; and, after parturition, when 
the marks on the uterus of pregnancy have disappeared, it is very difficult to 
decide, in any given case, between a true corpus luteum fast changing, or even 
more or less disappearing, and a spurious one, which has experienced the changes 
of two or three weeks after menstruation.'^ He, therefore, concludes that, in 
really doubtful cases, the corpus luteum presents distinctions of no decisive 
practical value. 

Bischoff here introduces another interesting point — the dependence of con- 
ception upon menstruation. We have already remarked that the periodic 
maturation and discharge of the egg is the primitive essential feature of the 
menstrual function in the human female. The menstrual flux is a secondary 
phenomenon; although, in the truly normal condition, there is an exact relation 
in all these parts of this function. The discharge of a sanguineous fluid would 
not, therefore, seem necessary for the process of conception to occur, provided 
all the other phenomena were present — such as a fit discharge of the egg, and 
a proper state of the uterine surface to receive and foster it. Pregnancy can 
and has occurred without menstruation,* that is, without the usual sanguineous 
discharge; but this is an abnormal state of things, and, as is well known, from 

founded upon well-conducted observation, is the prize essay of Dalton, already referred 
to. "The object of this paper is," using the language of its author, "to show that 
this conclusion of Pouchet [such as we have mentioned] is entirely erroneous ; that 
the corpus luteum of pregnancy is different from the corpus luteum of mensti-uation ; 
and that it may, under ordinary circumstances, be readily recognized and distinguished 
from it. 

Bischoff's view corresponds quite with that of Dalton, and the statements we have 
made in the text may be regarded as exponent of the views now entertained by most 
if not all recent inquirers. 

For an excellent historical resume of the subject of the corpus luteum, see Dalton, 
loc. cit. 

1 In these cases of the non-appearance of the usual menstrual discharge, it cannot 
for a moment be supposed that the ordinary decidual formation occurred nevertheless 
in the uterus ; and it is most probable that there was a discharge of some kind per 
vaginam, indicating that these changes were taking place. For a list of the recorded 
instances of such pregnancies, see Pouchet, loc. cit. p. 290. 



144 



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[July 



the earliest times, a regular complete menstruation has been deemed a requi- 
site of fruitfulness. But the inverse of this may be safely asserted as un- 
known, that is, that pregnancy can occur without this maturation and discharge 
of the egg, more or less coincident with some form of menstruation. There 
are many circumstances which may tend to disturb the healthy relations of the 
menstrual function, leading to its premature and too frequent recurrence ; such 
are, as is well known, change of climate, diet, and particularly sexual excite- 
ment. In these cases, although there may be changes and developments in 
the ovary, yet, in our opinion, they are all abnormal; thus, an egg may be 
prematurely ripened and discharged, or it may be matured but not discharged, 
the Graafian follicle being filled with blood. At least, the infertility of such 
individuals is well known. It would, then, seem pretty well determined that 
extraneous influences, such, particularly, as sexual excitement, cannot hasten 
the normal maturation and discharge of the egg, as has been supposed, and 
that all those conditions which superinduce some or all the apparent pheno- 
mena of too frequent menstruation lead to abnormal results or infertility. 

The last point we shall here take up, in connection with this interesting 
paper, is the time relatiom of the menstrual period or the maturation and 
discharge of the egg, to impregnation in the human female. 

In the first place, it should be stated that the result of experiment and 
reliable observation, so far, indic:ite that the egg is discharged from the ovary 
and received into the oviduct, not at the commencement^ but at the end of the 
menstrual period, or rather when there has been prepared in the uterine cavity 
a nidus for the egg's reception. Another fact, of a collateral character, to be 
here stated, is, that observation shows that the impregnation takes place while 
the egg is passing the oviduct, and most probably at the uterine end of this 
last. In fact, Bischoif says that, in all his observations upon mammalia, he 
knows of no instance where conception occurred after the egg had reached the 
uterus. From these data it may, therefore, be stated that the inclmive time 
of possible impregnation is that from the discharge of the egg from the ovary 
until it reaches the uterus; and that this period must be a longer or shorter 
one after the end of menstruation. But what is this period? Bischoff thinks 
it is from ten to twelve days' duration, and, therefore, that, as a rule, impreg- 
nation is possible only during this interval. This would probably stand as a 
correct and reliable statement, could normal conditions of this function be 
always predicated. Bat, in the human female, who is most often in a some- 
what abnormal state, subjected to the influences of art and luxury, &c., the 
possibilities of non-conception render the subject quite complex, open it to 
individual exceptions, and much impair the reliability of an application of the 
physiological rule. We will look to some of these possibilities. Thus, the 
egg may be delayed in its discharge from the ovary; or it may be discharged 
too soon, say during the menstrual flow. There are contingencies relating to 
its not meeting with the spermatic particles, and becoming ll-cundated. Other 
contingencies belong to what may be termed its not being properly nested after 
impregnation; these are, a tardiness of its passage through the oviduct, not 
reaching the uterus until the decidua has disappeared, or its normal passage 
through the oviduct, but reaching the uterus before the changes in the latter are 
fully complete; in other words, where there is a want of coincidence between 
the arrival of egg and uterine changes; or, finally, the egg having reached the 
uterus normally, it there meets no properly formed membrane or decidua, this 
last not being developed on account of weakness, sickness, &c. Last, but per- 
haps not least, in this category of contingencies, and which also will always 
\ render the more unsettled the whole subject, are possible relations of 
-yiatic particles. They may remain unchanged, and still alive, in the 



1854.] BischofiF, Human Ovidation and Menstruation. 



145 



vagina, or rather in the uterus, a long time, ready to meet any possibilities 
relating to the egg that may occur during the intermenstrual period. 

We need not enter upon further details of discussion of these contingencies and 
possibilities; most of them would be attended by non-conception, and that, too, 
often when all the general conditions would seem to favour the opposite state. 
Then, again, suppose that in the same individuals changes of life and habits 
have taken place, and then these abnormal conditions of want of coincidence 
between the action of all the parts are removed, conception may quickly occur 
just when it would have least been supposed; and this either after hitherto 
complete sterility, or an intervening unfruitfulness of perhaps only a few 
years. We would particularly insist upon these points as worthy of attention 
in connection with that most intricate and scarcely understood subject, sterilify. 

On the other hand, suppose conception is to take place — that is, the normal 
coincidences of ovarian, ovular, and uterine developments occur — yet there 
may be, as observation has already shown, individual peculiarities which affect 
and diversify the time relations of possible conception. Thus, the passage of 
the egg through the oviduct, and the formation of the decidua, may be rapid, 
and, therefore, impregnation possible only very shortly after menstruation. On 
the other hand, the inverse of this may be true, with a corresponding result. 

In conclusion, therefore, we may say that, although physiology and well- 
authenticated observation concur to show that impregnation is most possible 
during the twelve days succeeding menstruation, yet individual idiosyncrasies, 
combined with contingencies due to abnormal relations of life, seriously affect 
and unsettle the subject as having any practical value. 

Lastly, in this connection, we wish to advance a view which we have been 
disposed to entertain for some time. It is that, in the male of our species, there 
is a regular periodical sexual excitation, dependent upon constitutional relations 
alone, which corresponds to the monthly menstrual sexual excitement in the 
female. The ordinary conditions of life in our own sex, more or less constant 
occupation of the mind, the greater or less presence continually of outward 
sexual influences, these could well preclude the notice generally of any excess 
of sexual ardour at regular special periods during each month. But, in disease, 
where these conditions and influences are more or less removed, it might 
readily be noticed, especially in that class of chronic affections attended with 
some general febrile action, such as phthisis, &c. It was under such circum- 
stances that our attention was first called to the subject; and since, repeated 
inquiries have tended to verify this view. 

We would say, then, that there appears to be evidence that, in the human 
male, there is each month a period in which the sexual feeling and ardour is 
increased, and that, too, independent of external influences. This condition of 
the system here is attended, as in the female, with an exacerbation of the action 
of the whole vascular system, an increased physical or general animal feeling, 
and, finally, manifestations of plethora and excitement in the genitalia. No 
doubt there is at this period an increased formation of the spermatic particles; 
and the parts, becoming loaded with this secretion, if the natural mode of 
relief is not obtained, an emission, involuntary and generally at night, is the 
result; and this discharge is just as normal and necessary as that of any other 
overloaded organ or organs, and attended with a like relief. 

In disease, this monthly excitement has appeared to us indicated by an 
exacerbation of those symptoms which relate directly to the vascular system. 
Thus, in phthisis, the fever will be more marked, the cough more troublesome, 
and the tightness about the chest increased, conditions corresponding precisely 
to those of the female under the same circumstances. W. I. B. 



146 



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'[July 



Art. X. — An Enquiry into the Pathological Importance of Ulceration of 
the Os Uteri. Joeing the Croonian Lectures for the year 1854. By 
Charles West, M. D., Fellow of the Royal College of Physicians; Phy- 
sician Accoucheur to St. Bartholomew's Hospital; and Physician to the 
Hospital for Sick Children^ London, 1854. 8vo. pp. 95. 

It is time that an accurate and unbiased investigation should be made into 
the present condition of our knowledge as respects the diseases of the uterus, 
and their proper treatment; to determine how far the opinions promulgated 
in regard to uterine pathology are based on correct observation, and the reme- 
dial measures deduced from these opinions are calculated to fulfil the neces- 
sary indications. 

For a long period the several morbid conditions of the uterus were either 
entirely overlooked or their frequenc}^ and importance underrated, and, as a 
necessary consequence, their therapeutical management was irrational, ineffi- 
cient, and empirical. Of late years, however, an impulse in an opposite 
direction has been given to uterine pathology. Various morbid conditions of 
the uterus, but more especially of its os and cervix, are now considered by 
many physicians, not only to be of extreme frequency, but the cause of many 
of the derangements of the other organs, as well as of the various general 
disturbances of health, to which the female is liable. So far, indeed, is this 
metritic pathology carried by a few, that, in the investigation of the diseases 
of the female sex, they would seem to view the speculum uteri as of equal, if 
not more importance, than is the stethoscope in the exploration of the morbid 
conditions of the heart and respiratory organs. In too many instances, it is 
to be feared, that they have inverted the pathological series, and, in directing, 
too exclusively, their attention to certain abnormal conditions of the neck and 
orifice of the uterus, that have been brought to light since the introduction of 
the speculum, they have placed cause for elfect, and effect for cause, while man}^ 
important questions in reference to the diseased conditions of the uterus, their 
true character, causes, and results, have been allowed to pass without even an 
attempt at investigation. Nor does the evil stop here. The exclusiveness of 
the views referred to reacts injuriously upon him who entertains them. As 
Dr. West very truly remarks — 

"He unlearns what physiology might teach him of the uterus and its func- 
tions, and sees in all the varied manifestations of disorder the expression of 
one fact, and one fact alone; namely, the existence of ulceration at the orifice 
of the womb, and its reaction first on the uterine system, then on the general 
health. For him, indeed, there is little more to learn in uterine pathology; 
for when once a case has been ascertained not to be one of fibrous tumour, 
polypus, or cancer, then ulceration of the os uteri is the almost invariable 
cause to which the symptoms are referred, and the cure of this ulceration is 
the one grand object at which he endeavours. All the evils inseparable from 
the practice of a speciality are thus aggravated, and the natural tendency of 
such practice to subside into routine, or to degenerate into empiricism (I use 
the word in no invidious sense) becomes almost unavoidable. 

The frequency with which the uterus becomes the seat of disease, and the 
importance of all its morbid conditions in their influence upon the comfort, 
health, and, occasionally, upon the life of the female, are such as to demand 
from the medical practitioner, the closest investigation, that he may become 



1854.] 



West, Ulceration of the Os Uteri. 



147 



acquainted with their nature, their causes, and distinctive characters, and the 
means best adapted for their prevention and cure. 

In the lectures before us, Dr. West presents the results of a very logical 
and apparently candid inquiry into the pathological importance of ulceration 
of the OS uteri; a question of deep interest at the present day, in consequence 
of the disputes to which it has given rise. Although the conclusions to which 
the lecturer has arrived are in direct opposition to the opinions of those who 
maintain that inflammation of the cervix and ulceration of the os uteri are 
the first and the last links in the chain of uterine pathology, they neverthe- 
less claim the serious consideration of the medical practitioner. 

The important question discussed in these lectures is — 

"AVhether ulceration of the os uteri is to be regarded as the first in a train 
of processes which are the direct or indirect occasion of by far the greater 
number of the ailments of the generative system ; or whether, on the other 
hand, it is to be considered as a condition of slight pathological importance, 
and of small semeiological value — a casual concomitant, perhaps, of many dis- 
orders of the womb, but of itself giving rise to few symptoms, and rarely call- 
ing for special treatment?'' 

Dr. West arranges the evidence by which he has endeavoured to solve the 
question just stated under four principal heads : — 

Under the Jirst head is included the evidence deduced from what we know 
of the anatomy and physiology of the uterus in a state of health. The evi- 
dence derived from this source, Dr. West, however, admits, cannot from its 
very nature, be conclusive. 

" It may render a certain occurrence probable or improbable, may substan- 
tiate or disprove the correctness of certain opinions or explanations, but cannot 
invalidate the evidence of positive facts.'' 

Under the second head is included the evidence derived from morbid ana- 
tomy. Whether examination of the dead body shows the morbid conditions 
of the os uteri which have been described to be frequent or rare, slight or 
extensive; and whether we can make out what connection subsists between 
ulceration of the os and cervix uteri, and other changes in the tissues of the 
organ. 

"It must, however, be borne in mind," remarks Dr. W., "that many evi- 
dences of disease, such as are very obvious during life, may be greatly obscured, 
or may even entirely disappear after death : and further, that uterine disorders 
of the class which we are considering, though exceedingly painful, and seriously 
interfering with a woman's health and comfort, are yet not of a kind to prove 
the direct occasion of her death. Evidence derived from this source will there- 
fore be open to the objection that it understates both the frequency and the 
importance of these diseases." 

Under the third head is adduced the evidence derived from the characters, 
course, and consequences of ulceration of the os uteri, as it presents itself to 
our notice, unconnected with other disease, in the case of the procident uterus. 

"But," observes Dr. W., "whatever conclusions we may deduce from this 
source are open to all the objections inseparable from analogical reasoning. 
The probabilities of certain occurrences taking place in the uterus under other 
circumstances may be increased or weakened, but the evidence still falls short 
of absolute proof, either of the affirmative or of the negative character." 

Under the fourth head is comprised the evidence derived from clinical 
observation. The determination from clinical experience, as to the frequency 
of ulcerations of the os uteri under those circumstances in which they ordi- 



148 



Reviews. 



[July 



narily come under our uotice, and call, or are supposed to call, for our inter- 
ference, as well as the conditions generally associated with the ulceration, 
and the symptoms to which it commonly gives rise. 

"If," Dr. W. remarks, "the alleged symptoms of ulceration are found to be 
not rarely present without ulceration, and if ulceration is discovered even 
where there are no symptoms : or if, in the same case, the ulceration may vary 
in extent, with no corresponding change in the symptoms; if an indurated 
state of the cervix uteri exists without ulceration, and ulceration even of long 
standing, without induration — the conclusion, especially if supported by the 
answers obtained to our previous inquiries, seems to me irresistible, that the 
importance of inflammation of the cervix, and of ulceration of the os uteri, has 
been overstated ; that they are not the cause of all th^ symptoms which they 
have been alleged to occasion, and that, in the treatment of uterine disease, 
many other considerations must influence us more than the mere removal of 
ulceration of the orifice of the womb.'^ 

In regard to the testimony derived from anatomy and physiology, the lec- 
turer shows, that in organization and physiological importance the cervix is 
inferior to the body of the uterus ; that it is much less liable to morbid alter- 
ations in its intimate structure, and sustains, with surprising impunity, me- 
chanical violence and the contact of the strongest caustics. 

"But,''' he remarks, "if structurally so lowly organized — if physiologically 
of such secondary importance — if so much less subject than the body of the 
uterus to alterations in its intimate structure — and if so comparatively insen- 
sible even to rude modes of therapeutical interference — it certainly does appear 
to me that the assumption that some slight abrasion of the mucous membrane 
covering this part is capable of causing a list of ills so formidable as are attri- 
buted to it, ought to rest for its support upon some other and stronger founda- 
tion than any inference fairly deducible from anatomical or physiological 
data." 

Under the second head of evidence, Dr. W. presents the results of the 
examination of sixty-tico uteri taken from patients who died in the medical 
wards of St. Bartholomew's Hospital of other than uterine disease. 

" Of the total number, 13 were above forty-five years of age, the remaining 
49, between the years of fifteen and forty-five. Concerning all of the former 
class, and 30 of the latter, making a total of 43, it was either known with 
certainty, or concluded with great probability, that they were married, or had 
had sexual intercourse ; the remaining 19 were believed to be virgins. 

"The subjoined table shows the general results of the examination of the 
uterus in these cases, and the relations borne to ulceration of the os uteri by 
the more important morbid appearances. 

Uterus healthy in 33 

" diseased in . 29 

Ulceration of os uteri in 17 

Ulceration existed alone in 11 

" with diseased lining of uterus in . . 3 
" with induration of walls of uterus in . 3 

— IT 

Induration of walls of uterus, without ulceration of os 5 
Disease of lining of uterus, without ulceration of os . 7 

Total of diseased uteri, ... 29 

" The OS uteri was abraded in one of the subjects above forty-five years of age, 
and the lining of its interior was diseased in five of that number. In eleven of 
the nineteen patients, all under forty-five years old, who were virgins, the uterus 
was perfectly healthy ; in eight, it presented some sign or other of disease. This 



1854.] 



"West, Ulceration of the Os Uteri. 



149 



consisted five times in slight abrasion of the os uteri, which existed alone in 
three cases, but was associated in the other two with some morbid state of 
the interior of the womb. Twice the interior of the uterus was the only part 
affected, and once the uterine walls were much harder than natural. 

"There is certainly something," remarks Dr. W., " at first not a little start- 
ling in the result at which we arrive, that the womb was found in a perfectly 
healthy condition in little more than the half of sixty-two women, none of whom 
died of uterine disease, nor were supposed to be suffering from any grave uterine 
ailment. But it may, it ought indeed, to be asked, what is the value of these 
appearances? Some of them may be of little moment, and the very frequency 
of their occurrence, instead of substantiating the opinion that they are of great 
importance, rather militates against that supposition. When ulceration of the 
OS uteri was first observed it was natural enough to attribute to it many symp- 
toms, and to refer to its influence many structural changes. But what if such 
ulceration be found to be usually very limited in extent, and so superficial as 
to be unassociated with changes in the basement membrane of the affected sur- 
face, and exercising so little influence on the state of the uterus in general as 
to be unconnected, in a large number of instances, with changes either in the 
interior of the womb or in its substance, while induration of the uterine tissue 
and disease of the lining membrane of the womb are found independent of it or 
of each other? Should such appear to be the case, it will,! think, be rendered 
in the highest degree probable that this abrasion of the os uteri has not the 
long train of sequences wdiich have been supposed to follow^ it, but that it is of 
comparativel}^ small pathological import; that it may be found to vary under 
the influence of comparatively trifling causes; and not unfrequently to be de- 
pendent on functional disorder of the uterus, just as the mucous membrane of 
the tongue and mouth betrays the disturbance of the digestive system ; that it 
may, in short, be the consequence and sometimes the index, but rarely the occa- 
sion of the ailments with which it is associated. 

" Abrasion of the os uteri was observed in eleven instances unconnected with 
any other morbid condition of the womb. In six cases it was extremely slight, 
affecting just the edges of the os uteri, but not extending for more than a line 
in breadth ; the mucous membrane lining the canal of the cervix was in all of 
these instances quite pale, but twice the lining of the uterine cavity was of a 
brighter red than natural. In the other five cases, the abrasion, though retain- 
ing the same character, was more extensive ; once the abraded surface presented 
a finely granular aspect, but was quite uniform ; but in the other four cases it 
had an uneven worm-eaten appearance, probably due to a partial destruction of 
the papillae which beset the os uteri. In four of these cases the abrasion ex- 
tended for a short distance up the canal of the cervix, while once it was limited 
to that exclusively, the lips of the os being perfectly pale and healthy, and the 
mucous membrane of the cervix unaltered, excepting along a strip of a third of 
an inch in breadth by an inch in length, where the posterior wall was abraded. 
In three of the above four instances there was some increase of vascularity in 
the mucous membrane of the cervix, which on one occasion extended for nearly 
half an inch up its canal; and once this condition was very marked, and the 
mucous membrane appeared swollen and infiltrated, but in no other case was 
there any appearance of thickening of the membrane either at the seat or in the 
immediate neighbourhood of the abrasion." 

" Under what circumstances is induration of the uterine tissue met with, and in 
connection with what other changes in the organ ? It existed in nine cases: in 
five of which it was not associated with any other disease of the uterine sub- 
stance ; in three, it coexisted with ulceration of the os ; and in one, w^ith a morbid 
state of the interior of the uterus. In an unmarried girl, aged eighteen, who 
died of cardiac dropsy, the tissue of the fundus, and of the upper half of the body 
of the uterus, presented its usual characters ; but about half-way down the body 
of the organ there began a strip of a dead yellow colour and much denser tex- 
ture, resembling fibro-cartilage or the elastic coat of an artery. The dense tissue 
lay immediately beneath the lining membrane of the uterus, and being at first 
only one line in thickness, increased in width till it came to constitute the whole 
thickness of the cervix uteri. In the case of another patient, aged forty-seven, 



150 



RevieiDS. 



[July 



a similar condition was met with in the body of the uterus, but scarcely at all 
involved the cervix; and in the three other cases, in all of which the women 
were under thirty years old, the cervix uteri alone was atfected, bein^ white, 
hard, creaking under the knife, and seeming, under the microscope, to be com- 
posed of an extremely dense fibrous tissue. 

*' It appears, then, that most marked induration of the tissue of the cervix, and 
of part of the body of the womb, may exist where there is no other trace of 
inflammation either past or present. It may also occur in connection with in- 
flammation and ulceration of the lining membrane of the uterine cavity. In a 
woman, who died at the age of fifty-six, about a third of the thickness of the wall 
both of the body and neck of the womb was exceedingly firm and creaked under 
the knife. Abundant glairy secretion from the cervical glands, and some want 
of transparency of its lining membrane, Avere the only unusual conditions of the 
interior of the uterine neck; but the cavity of the organ contained a copious 
purulent secretion mixed with blood ; its mucous membrane was thickened, 
vascular, and destitute of polish, and about the middle of the posterior wall 
completely destroyed, leaving the substance of the womb beneath uneven, rather 
soft, and presenting the appearance of a granulating surface. 

"Ulceration of the os uteri, and induration of the uterine walls, were asso- 
ciated together in three instances. On one occasion the ulceration was but 
slight, and the interior of the cervix extremely pale, though there was great 
injection of the lining of the uterine cavity. In this instance the cervical wall 
was much indurated, that of the body of the uterus rather less so. Extreme 
induration of the cervix existed in one case where there was rather extensive 
ulceration of the os uteri; and, in this instance, the cervix was considerably 
hypertrophied. The patient from whom this uterus was taken had been under 
my care for some years previously, suffering from symptoms such as Gooch 
describes under the name of irritable uterus ; her suiferings had been most 
severe, and the enlargement of her womb most considerable at a time when 
there was no abrasion of its orifice. In one case only, in which there was con- 
siderable induration of the cervix, there was a distinct line of congestion about 
half a line in depth, between the ulcerated surface and the pale tissue of the 
indurated cervix. 

"In ten cases, the condition of the lining membrane of the uterine cavity de- 
viated from that which characterizes it in a state of health. Thrice this state 
of the interior of the womb coexisted with ulceration of its orifice of moderate 
extent, and presenting its ordinary appearance ; but in the remaining seven 
instances the os uteri was perfectly healthy. In seven of the ten cases the ute- 
rine mucous membrane was vividly injected so as to present a bright rose tint, 
and was more or less swollen and softened. Once very extensive disease of the 
lining membrane of the uterine cavity, probably of a tuberculous character, was 
discovered in the body of a woman fifty-six years old. In a second case, in which 
the patient was stated to have had a copious leucorrhoeal discharge, and to have 
complained of pain and of a sense of heat at the lower part of the abdomen, the 
intensely red mucous membrane of the uterine cavity presented an almost gela- 
tinous appearance, and looked not unlike decidua. In this instance, though 
there was some ulceration of the os, yet the lining membrane of the cervix was 
quite pale ; no secretion occupied its canal, and the tissue of the uterus was 
quite healthy. In a third case, a small patch of ecchymosis was present beneath 
the lining of the uterine cavity; and in a fourth, where the patient had not 
menstruated for five months, the lining membrane, though of a pinkish colour, 
had lost its polish, and looked more like an injected serous membrane than like 
the mucous lining of the womb." 

In relation to many of the above abnormal appearances, they ought probably^ 
Dr. W. believes, to be classed with pseudo-morbid rather than with patholo- 
gical conditions ; but the data, he remarks, at present fail us for distinguishing 
with accuracy the one from the other. 

" But, be this as it may, it is yet abundantly evident that many of them 
imply deviations from a healthy state more considerable than the trifling abra- 



1854.] 



West, Ulceration of the Os Uteri. 



151 



sion or ulceration of the os uteri, -u'hich existed on several occasions, AYe have 
seen that, in by far the majority of cases, the ulceration, when present, was not 
merely trifling in extent, but that it had not given rise to so much irritation of 
the neighbouring tissues as to produce any appreciable congestion of the mucous 
membrane in its vicinity, while the changes in the uterine substance alleged to 
depend upon it were oftener present without than in connection with it; and, 
moreover, none of the alterations about the os and cervix of the womb were so 
considerable as those which were a;pparent in its cavity/' 

Under the third head of evidence, Dr. W. examines the effects commonly 
produced by ulceration of the os uteri in cases of prolapse of the womb beyond 
the external parts, and the symptoms to which it generally gives rise, and 
where we can trace the ulceration in its progress; can watch it for weeks or 
months together, and even see what it has led to when it has existed for 
years, 

" It can scarcely be necessary to say," remarks Dr. "W, in summing up his 
conclusions under this head of the inquiry, "that it is not my intention for one 
moment to assert that misplacement of the womb produces no inconvenience, 
or that ulceration of its orifice, when it is thus misplaced, is of no importance. 
Daily experience yields abundant proof to the contrary ; but a detail of the 
symptoms of prolapse of the uterus forms no part of our present object. I re- 
ferred to the accident and its consequences only for the sake of suggesting the 
reasonable inference that, if inflammation of the neck of the womb were as fre- 
Cjuent as has been supposed, or, ulceration of its orifice the necessary occasion 
of such serious disorder of function and alteration of structure, we ought to meet 
with some of the most striking illustrations of these facts in cases where the 
womb, by its misplacement, is exposed to injuries from without, such as it was 
never intended to encounter. 

" But though it be conceded, as I think it must be by all observers, that the 
symptoms supposed to characterize inflammation of the neck of the womb, and 
ulceration of its orifice, are not met with either constantly or in a specially 
marked degree in cases of prolapsus or procidentia uteri ; still, we should not 
be justified in drawing an absolute conclusion from what we observe in the mis- 
placed uterus, as to the effects produced by similar ailments attacking the organ 
when in its natural position. It may be alleged, and with plausibility, that 
during the gradual process of its displacement, the sympathies of the womb have 
been rendered less keen than they Avere while the organ retained its natural 
position; and that thus it comes to bear, with comparative impunity, injuries 
which might otherwise have produced great disorder of its functions and great 
alteration of its tissue." 

Under the fourth and last head of the inquiry : What clinical observation 
generally teaches us concerning ulceration of the os uteri, its course, its symp- 
toms, and its importance? the questions to which especial attention is directed 
by the lecturer are, whether sterility is more frequent, whether the rate of 
fecundity is lower, and whether abortion occurs oftener in cases marked by 
the presence of ulceration of the os uteri than in those in which ulceration is 
not present? Whether menstrual disorder is more common, more severe, or 
different in kind • whether leucorrhoea is more abundant, or furnished from a 
different source; or whether pain is less tolerable in the one class of cases 
than in the other. And, lastly, whether similar or different causes produce 
the uterine affections in the two classes of cases; whether the duration of ill- 
hess is the same, and whether the structural alterations of the womb are alike 
or diverse? 

The materials from which the lecturer has endeavoured to make some 
approach to a satisfactory answer to these questions are derived from 1226 
cases, of which records were preserved while the patients were under his care, 
either at the Middlesex or at St. Bartholomew's Hospital. Of these, 300 



152 



Reviews. 



[July 



were in-patients of one or otber institution, and the remaining 926 were out- 
patients of St. Bartholomew's Hospital, between January 1, 1850, and Octo- 
ber 15, 1853. 

The investigation of the materials thus derived, as presented by the lecturer; 
the analysis and collation of the facts they present in their bearing upon the 
questions proposed for investigation, are valuable and interesting ; they are 
well deserving of a careful and candid examination. We shall not pretend to 
present an abstract of them. To form a just estimate of their accuracy and 
the correctness of the author's deductions from them, they must be studied in 
detail. We can only lay before our readers the general conclusions to which 
the author has been led. 

" 1. Uterine pain, menstrual disorder, and leucorrhoeal discharges — the 
symptoms ordinarily attributed to ulceration of the os uteri — are met with 
independently of that condition almost as often as in connection with it. 

"2. These symptoms are observed in both classes of cases with a vastly 
predominating frequency at the time of the greatest vigour of the sexual func- 
tions, and no cause has so great a share in their production as the different 
incidents connected with the active exercise of the reproductive powers. But 
it does not appear that ulceration of the os uteri exerts any special influence, 
either in causing sterility or in producing abortion. 

"3. While the symptoms are identical in character in the two classes of 
cases, they seem to present a slightly increased degree of intensity in those 
instances in which ulceration of the os uteri existed. 

"4. In as far as could be ascertained by careful examination, four-fifths 
of the cases of either class presented appreciable changes in the condition of 
the uterus — such as misplacement, enlargement, and hardening of its tissue, 
while frequently several of these conditions coexisted. An indurated or hy- 
pertrophied state of the cervix uteri was, however, more frequent in connection 
with ulceration of the os uteri than independently of that condition. 

"5. The inference, however, to which the last-mentioned fact would seem 
to lead, as to the existence of some necessary relation — such as that of cause 
and effect — between ulceration of the os uteri and induration of its cervix, is 
in great measure negatived by two circumstances: — 

"1. The number of instances in which an indurated cervix coexisted with a 
healthy os uteri. 

• " 2. The fact that, while induration of the cervix was present in 25 out of 
46 cases in which the ulceration of the os M^as very slight, it was altogether 
absent in 9 out of 16 cases in which the ulceration was noted as having been 
very extensive." 

Thus, it will be perceived that the final conclusion of Dr. West's inquiry 
into the pathological importance of ulceration of the os uteri is, that such 
ulceration is neither the general cause of the symptoms which have been attri- 
buted to it, nor even a general concomitant of them, and an index of their 
degree and severity. 

In the third and concluding lecture. Dr. W. enters into a brief inquiry into 
the actual causes of the various morbid phenomena, that are considered by 
many as dependent solely upon ulceration of the os uteri. 

These causes he believes to be very various, sometimes independent of local 
disease, as in the case of chlorosis, of hepatic disorder, of granular disease of the 
kidneys, of the gouty or rheumatic patient, all of which instances illustrate 
the dependence of uterine disorder on constitutional disease. Ulceration of 
the OS uteri, when it occurs in such cases. Dr. W. considers to be of secondary 
importance, and equally so in many instances where disease really begins in 
the uterus itself, as in ailments succeeding to pregnancy, abortion, delivery, 
etc. In these latter cases. Dr. W. believes that the mischief commences in 
the interior of the womb as well as in other instances where the symptoms of 



1854.] 



West, Ulceration of the Os Uteri. 



15B 



sexual disorder have succeeded to marriage, or where they have followed sup- 
pressed menstruation, and in those also in which uterine misplacements are 
succeeded by signs of sexual disorder, or where these signs have been associated 
with misplacement of the ovary. 

Referring to the treatment pursued by those who advocate the pathological 
importance of ulceration of the os uteri, Dr. W. remarks : — 

" It may be asked, how is it that such successful results have followed a 
course of treatment directed exclusively to the cure of the ulceration — that the 
applicatiun of caustic to the os uteri has been succeeded by the restoration of 
the patient to health? Now, I think, it should be borne in mind that, in con- 
nection with this mode of treatment, various other measures are of necessity 
adopted, eminently calculated to relieve many of the slighter forms of uterine 
ailment. The married woman is for a time taken from her husband's bed, the 
severe exertion to which either a sense of duty urged, or a love of pleasure 
prompted her, is discontinued ; while rest in the recumbent posture places the 
uterus and the pelvic viscera in just that position in which the return of blood 
from them encounters the smallest difficulties. The condition of the bowels, 
probably, before habituallyneglected, is now carefully regulated, and the patient's 
diet, bland, nutritious, and unstimulating, often differs widely from that Avith 
which, Avhile all her functions were over-taxed, she vainly strove to tempt her 
failing appetite. Add to this, that the occurrence of the menstrual period is 
carefully watched for; that all precautions are then redoubled, and each symp- 
tom of disorder, such as, on former occasions, had been borne uncomplainingly, 
though often not without much suffering, is at once encountered by its appro- 
priate remedy; while, generally, returning convalescence is met in the higher 
classes of society by a quiet visit to the country, or to some watering-place, in 
pursuit not of gayety but of health ; and we have assembled just those condi- 
tions best fitted to remove three out of four of the disorders to which the sexual 
system of woman is subject. But the very simplicity of these measures is a bar 
to their adoption ; for you wnll bear me out in saying, that the rules which com- 
mon sense cannot but approve, but which seem to require nothing more than 
common sense to suggest them, are just those to which our patients least readily 
submit. The case is altered, however, when these said rules are laid down not 
as the means of cure themselves, but only as conditions indispensable to the 
success of that cauterization which, repeated once or oftener in the week, is the 
great remedy for the ulceration that the doctor has discovered, and which he 
assures his patient, and with the most perfect good faith, produces all the symp- 
toms from which she suffers. The caustic used in these milder cases is the 
nitrate of silver; the surface to which it is applied is covered by a thin layer of 
albuminous secretion, which it is not easy to remove completely, and which 
serves greatly to diminish the powder of the agent, while the slightly stimulating 
action that it nevertheless exerts seldom .does harm ; sometimes, I believe, does 
real good, though no more than might have been equally attained by vaginal 
injections, or other similar remedies, which the patient might have employed 
without the intervention of her medical attendant.'^ 

Notwithstanding it is the conviction of Dr. West, that in the great majority 
of instances in which the nitrate of silver is applied to the os uteri, the pro- 
ceeding is simply superfluous, while to the use of caustic potash in cases in 
which the neck of the womb is more or less enlarged, he is altogether adverse, 
still, he admits that there are some exceptional cases in which ulceration or 
some allied morbid condition of the os uteri is found to exist, independent of 
any appreciable disease elsewhere^ and others, equally rare, in which, after 
symptoms of uterine ailment have been subdued, a morbid state of the os uteri 
persists, that are benefited b}^ stimulant applications. 

"In such cases," he observes, " I use either the nitrate of silver, or the acid 
nitrate of mercury, though neither of them frequently; and for weeks together 
no case appears among ray patients at St. Bartholomew's Hospital, in which 



154 



Reviews. 



[July 



the employment of either apy)ears to me indicated. In justice to others, it 
should, I think, be observed, that we have no right to infer that the majority 
of practitioners vrho resort to these agents with much greater frequency than 
some of us feel warranted in doing, regard them as absolutely the best reme- 
dies that could be used, but merely as the best under the peculiar circumstances 
in which uterine diseases have to be treated. Were it possible to keep any of 
those milder agents in contact with the abraded os uteri which can generally be 
applied to an irritated or ulcerated surface elsewhere, this would doubtless be 
allowed, in many instances, to be a preferable proceeding. The problem, how- 
ever, is to find some agent sufficiently powerful to exert an influence which 
may continue for several days, and thus to obviate the necessity for that fre- 
quent painful interference which would otherwise be required. That lotions, 
baths, and other remedial agents, which may be safely entrusted to the patient 
herself, will answer the desired ends more frequently than some practitioners 
imagine, is my firm conviction, but I could not refrain from stating what seems 
to me to be the candid interpretation of their conduct who pursue a different 
course of proceeding.'^ 

We have thus endeavoured to present to our readers an exposition of the 
views to which Dr. West has arrived in relation to the pathological value of 
ulceration of the os uteri and its proper treatment. We bespeak for his lec- 
tures a careful and candid study on the part of the physicians of the United 
States, believing them to be calculated to impart important suggestions in re- 
ference to the true character and pathological relationship of these ulcerations, 
and their correct therapeutical management. The series of facts presented by 
the lecturer, and the deductions to which he believes them to lead, place ulcera- 
tion of the neck and orifice of the womb in a point of view that has almost 
entirely escaped the attention of the leading writers on the subject, and indi- 
cate a plan of treatment of the cases in which it occurs more rational and less 
objectionable than the one now almost universally practised. 

D. R C. 




1854.] 



155 



BIBLIOGIUPHICAL J^OTICES. 

Art. XI. Clinical Eeport on Dysentery, based upon an Analysis of Forty-nine 
Cases, with Remarks on the Causation, Pathology, and Management of the 
Disease. By Austin Flint, M.D. Buffalo, 1853— pp. 90. 

Clinical Report on Chronic Pleurisy based on an Analysis of Forty-seven Cases. 
By the same — pp. 58. 

These reports were originally published in the Buffalo Medical Journal. 
They have been reissued in their present form with the hope " that they may 
prove acceptable to some who are not readers of the periodical just named." 
To all physicians who justly appreciate the results of pure observation, they 
will undoubtedly be welcome as an addition to positive knowledge, and as a 
pledge that the principles upon which they have been framed will be widely 
disseminated by the professional lessons of their author. If we were to say 
that they contain nothing new, the statement would perhaps be literally cor- 
rect, yet it would be far from warranting the conclusion that they are deficient 
in value. On the contrary, we regard them as of great value, because they 
lend -the support of demonstration to doctrines and to modes of practice, some 
of which have rested too much upon authority ; and they show with equal clear- 
ness the groundless nature of certain prevalent opinions. But their highest 
worth consists in their being models of patient and candid investigation — 
studies of nature under the guidance of a severe analytical method. The spirit 
which presided over their construction is so eminently a rational and con- 
scientious one that the comparative paucity of their results may be overlooked 
in favour of the value of their example. This spirit the author himself illus- 
trates didactically in the opening to the first-named report. We commend 
his remarks to the careful perusal and reflection of those who do not, as well 
as to those who will not, understand the application of numerical analysis to 
medical facts. 

The subject of the first report is Dysentery. Its phenomena are analyzed in 
various sections, including the previous condition of the patient, the symptoms 
of invasion, those of the fully established^ disease in the digestive, circulatory, 
and other systems, each by itself, its duration, &c. We shall note a few of the 
prominent results which are developed by the analysis. Nearly all of the cases 
occurred in the months between July and October inclusive. There was no 
antecedent diarrhoea that did not evidently belong to the dysenteric disease. 
The prognostic value of several varieties of alvine evacuations is thus given : 
fibrinous laminae were present only in tjie grave and fatal cases, and sero- 
sanguinolent stools (lotura carnium) when copious, were of most serious and 
generally fatal import. If the pulse, says Dr. Flint, exceed 120 in the adult, 
the patient is in considerable danger, and the danger increases in a geometrical 
ratio as the pulse rises above this point, and in the same ratio to the rapidity 
of its rise. Delirium occurred in no case that recovered; but, in five out of nine 
fatal cases it was present, and in three of these was of a maniacal form. It is 
stated that of thirty cases whose duration was known, thirteen were in hospi- 
tal and seventeen in private practice. The mean duration of the former was 
thirteen days, and of the latter only seven days. As regards mortality, twenty- 
seven patients were in private, and twenty-two in hospital practice ; of the first 
class eight died, and of the latter, three. Consequently, the mean duration of 
the disease was shorter, and the mortality greater, in private practice. The 
author explains this by suggesting that the patients in the hospital were more 
favourably situated for successful treatment than those in private practice. 
Might the reason not have been that the cases in private practice comprised 
tAvo classes, the one of patients who were so lightly attacked that their removal 



156 



Blhliograpliical Notices. 



[July 



to the hospital was thought to be unnecessary, and the other of such as were 
too ill to be carried thither ? In no case was there any relapse, nor has tJie 
author ever met with a second attack of dysentery in the same person. 

The result just quoted is, we believe, quite novel, and it is opposed to 
the positive statements of several writers. Dr. Flint does not assert, but he 
is disposed by the results of his own experience to suspect, that such state- 
ments have been made incautiously. The question is a very interesting one. 
As indirectly bearing upon it, the author presents several reasons for regard- 
ing dysentery as something more than a colitis — as having a specific nature 
which would entitle it to be ranked amongst the diseases which attack but 
once in a lifetime. The proofs of its possessing such a nature he discovers in 
the character of its cause. This he affirms to be occult, because, among other 
reasons, no obvious source can be assigned for it; because its prevalence is 
confined to certain periods and places when and where no appreciable new 
cause of disease is in operation; because of its apparent analogy to diseases 
which attiick but once, &c. 

The author inquires how far we possess a knowledge of the intimate nature, 
or, as he not very correctly styles it, the pathology of dysentery. lie proves 
clearly enough, in connection with the argument just referred to, that the dis- 
ease is not merely a colitis ; but he fails, as all have failed, in showing what 
other pathological elements it comprises. 

In considering the treatment of dysentery, the author gives a negative answer 
to the question : Have any remedies been found to exert a specific control over 
dysentery? He is then at some pains to determine the indications of a rational 
treatment, but arrives at the inevitable conclusion that the best remedies are 
those which have been found best. It is in vain to lay down gravely such rules 
as that the objects of treatment in this affection are " to endeavour to prevent 
or abate the severity of the local manifestations of the disease ; to relieve the 
symptoms incident thereto; to obviate unfavourable events," &c. They 
amount to nothing more than that the symptoms of the disease individually or 
collectively are to be opposed by remedies which experience has shown capable 
of palliating or removing them; not individual experience, nor that of any one 
place, season, country, or period of time, but the resultants of all the various 
combinations of these elements, and not the common or average resultant of all 
experience of the disease under the various circumstances mentioned. That 
would be to establish a therapeutical formula inapplicable to any individual 
case, or epidemic, or locality. Sound inductive reasoning would go no further 
than to apply the results of treatment in a group of cases of the same kind to 
another group of analogous cases. That is the nearest approach which the art 
of therapeutics can make to a scientific expression or application. Our author 
says that " diseases must be treated, to a greater or less extent, on rational 
principles — that is to say, principles belonging to general therapeutics applied 
to the management of particular affections analogically or d priori." It would 
be interesting to witness the treatment of a case even of pure sthenic dysentery 
on "rational principles" by a person who had never before seen or heard of 
the disease. Would he use purgatives or astringents? 

Dr. Flint is no advocate of the lancet in dysentery, although he thinks cases 
now and then occur which it might benefit. Of j^urgatives, and particularly 
those of the saline class, he is disposed to think favourably ; but less from bis 
ovrn experience than that of others. We hope that he may have an opportu- 
nity of trying them in sthenic cases and near onset of the attack. There is 
little doubt of his esteeming them still more highly than at present. Mercury 
is dismissed by our author as a remedy introduced into the treatment of the 
disease, and still retained upon hypothetical grounds alone. He says, and we 
agree with him, that it was a happy thought to make its combination with 
opium the condition of its success. Of opium itself, he can only say that he 
subscribes to the undeviating testimony of practitioners through many ages in 
its favour. He prescribes it in large — we may say in sometimes very large 
doses. lie has even known " twenty-four grains of the sulphate of morphia to 
be taken in twenty-four consecutive hours by a patient not habituated to the 
use of opium, witli no evidence of narcotism ; nor could this quantity be dimi- 



1854.] Regidry of Births, Marriages, and Deaths, in Kentucky. 157 



nished without marked aggravation of the symptoms." His impression of the 
utility oi astringents, derived from his own experience, is unfiivourable. Even 
astringent enemata did not appear to him useful except so far as they favoured 
the retention of the opiates which they contained. This opinion, if applied to 
small enemata, we should subscribe to ; but not if it relates to such as are 
large enough to reach the colon and be retained. The effect of these upon the 
frequency of the discharges is always striking. The author lays great stress 
on the importance of administering diffusible stimulants and nviriment system- 
atically. He says : "I am convinced that, with a due appreciation of the 
importance of supporting measures, on the part of the practitioner, together 
with promptness, boldness, and perseverance in their use, and a careful super- 
vision of all the details which they involve, patients are sometimes carried 
safely through this disease, when the gravity of the affection is such that a 
fatal termination would otherwise be inevitable." He has frequently found 
the pulse to lose its excessive frequency under their liberal use, and the safe 
passage of the crisis of the attack to depend upon their artificial support. To 
rightly employ these agents in dysentery requires much tact and judgment; 
for as much harm may be done by their untimely or undue administration as 
by withholding them altogether. 

The Report on Chronic Pleurisy offers less interest than the one which has 
just been noticed, because, in most cases, this affection is a very simple one — is, 
in fact, rather an infirmity than a disease; and the questions concerning it 
mooted by our author scarcely divide the opinions of medical men. It would 
appear, however, that a portion of the profession is less informed upon the 
subject than could have been-' expected, for, in eighteen cases out of forty- 
seven analyzed by Dr. Flint, an error of diagnosis had been committed. The 
affection had been mistaken for "disease of the heart, abscess between the 
pleura and the walls of the chest, bilious fever, hepatization of lung, liver com- 
plaint, general debility, and some pulmonary affection, the nature of which 
was confessedly not known. It is to be hoped that the possibility of such 
errors is diminishing every year ; but, while clinical instruction is regarded 
as a superfluous branch of medical education by many of our colleges, a long 
period must elapse before even such gross blunders will cease to be made. 

In four cases of the author's series, pleurisy was developed by perforation of 
the lung, which in two cases was tuberculous, and, in the other two, gan- 
grenous. 

The medicinal treatment of chronic pleurisy was found by Dr. Flint to be of 
secondary value, and, in this respect, he agrees with good observers generally. 
He noticed in several cases, however, an apparent subsidence of the effusion 
under the use of diuretics, particularly squill, digitalis, and the supertartrate 
or nitrate of potash. But these agents were generally associated with mercury, 
so that their effects, and that of the latter medicine, cannot be strictly esti- 
mated. The influence of tonic remedies, diffusible stimulants, a generous diet, 
moderate exercise in the open air — and particularly of the last of these — was 
much more decided. This fact harmonizes well with the view that a serous 
effusion in the pleural cavity is not, in strictness, a disease. 

The reports which have been thus briefly noticed are so excellent in their 
spirit, and, considering the imperfection of the materials, so satisfactory in 
their execution, that we cannot but anticipate from their author still more 
important contributions to the literature of practical medicine. A. S. 



Art. XII. — First Annual Beport to the General Assembly of Kentucky relating 
to the Registry and Returns of Births, Marriages, and Deaths, from January 1 
to December 31, 1852. 

This brochure contains 112 octavo pages; of which more than 100 consist of 
statistical tables, presenting a very unprepossessing object for the eye of the 
general reader. Owing, however, to some rather singular predilections, we 
No. LV.— July 1854. 11 



158 



Bibliographical Notices. 



[July 



have been tempted to look into the contents, among -which we have found mate- 
rials capable of being worked up to no little profit. 

In establishing this system of general registration, Kentucky has commenced 
a noble work — one which reflects credit on her physicians, by whom it was 
originally devised, and the statesmen by whose legislative action it was con- 
summated. It requires considerable intelligence to comprehend the advantages 
to be derived from a mass of minute records of deaths, births, and marriages, 
accumulated through years of labour, and at no little cost. But in the bands 
of the skilful statistician such details reveal facts of the greatest value to the 
public. They teach us where the causes of mortality most abound, and thus 
admonish us to adopt plans for removing malign influences and for promoting 
health. They show the average duration of human existence, and thus lead 
to more perfect computations of the chances of life upon which companies 
for life insurance and granting annuities, found their calculations. Those who 
consider the bearings of such institutions upon the security of property, and 
lessening the risks of individuals, and more especially of the most helpless and 
dependent members of families, may form some idea of the value of data which, 
like all correctly kept life-tables, serve as the basis of life insurance and annuity 
computations. Such are a few of the more direct advantages derived from a 
registration of deaths, with the ages at which these occur. In regard to mar- 
riages and births, records are extremely valuable as establishing many facts of 
great value to the political economist, and the proper succession of property, as 
well as to the illustration of physiological laws. In all countries where the 
affairs are managed by the most intelligent of the population, systems of regis- 
tration "are carefully maintained, and we therefore regard the establishment of 
these in the various States of our Union as direct evidences of the wisdom by 
which the governments are administered. With the first year's Kentucky re- 
port, and the elaborate eleventh year's return from Massachusetts on our table, 
we scarcely know what to say of the abortive attempt to introduce a system of 
registration into Pennsylvania, where a law enacted two years ago remains a 
dead letter. This is a disgrace to our State, which we trust will be removed 
ere long. 

The Auditor of the State of Kentucky, Thomas S. Page, Esq., whose duty 
it is to render the Registry Returns to the General Assembly, remarks in his 
communication, that — 

" As this is an entirely new measure in our State, considerable difiSculties 
and imperfections were anticipated in getting the law into operation. It is the 
more gratifying, therefore, that I am enabled to say that, although there are 
many imperfections, and some very gross negligence, yet, altogether, the enter- 
prise thus far has been eminently successful — it is believed much more suc- 
cessful than in any other State during the first year. 

" Having ascertained about the middle of September that, with the clerks in 
my office, it would be impossible for me to digest and arrange the assessors' 
returns in a proper manner within the time prescribed by law, and as there 
were very serious difficulties attending the subject, without the personal super- 
vision of a person versed in the phrases of the medical profession, I procured 
the services of W. L. Sutton, M. D., of Georgetown, under whose super- 
vision and direction this report has been prepared.^' 

In a communication addressed by Dr. Sutton to the Auditor, transmitting 
his report, together with the assessors' books, blanks, &c,, he refers to many 
of the difficulties encountered in the initiatory stages of a registration law. 
We make from it the following extracts for the benefit of those in other States 
■who may follow in the same track: — 

" I received returns from every county in the State. These returns are very 
generally m.ade in a form highl}^ creditable to the gentlemen who made them 
out. There are doubtless many omissions in the returns (perhaps from every 
county), vet, upon the whole, they are much nearer being full than couid 
reasonably have been anticipated at the first effort; and it is believed more full 
than those produced from any State heretofore at the commencement. 

" In the returns from various counties, there have been great difficulties in 
determining the colour, and sometimes the sex, in particular instances. After 



1854.] Registry of Births^ MarriageSj and Deaths, in Kentucky, 159 



the tables had been nearly completed, it was ascertained that the number of 
births and of deaths returned from Simpson County was the same. This gave 
reason to think that there might be a mistake somewhere. Accordingly, upon 
examining the returns, it would seem that the returns made to the Auditor's 
office from that county, consisted of the original return of the assessor as to 
births, and the same copied into the schedule for deaths, as far as one schedule 
could be made to agree with the other. It is therefore highly prohahle that all 
the tables are wrong, so fiir as the deaths of Simpson are concerned. Never- 
theless, as they appear in the proper schedule, I have permitted them to re- 
main in the tables. 

"With the schedule of deaths from Meade County, I have not been able to 
do anything. There are, indeed, entries under all the heads of the schedule ; 
but the one-half of each entry is evidently wanting, and no possible connection 
between the entries on opposite pages can be perceived. This schedule is 
therefore thrown out. 

" From these causes, and from the inherent difficulty in making so many 
calculations, and constructing so many long tables, this has been an exceed- 
ingly laborious and perplexing piece of work ; nor dare I say that there are no 
errors in it. I do say, however, that no pains which the time allowed have 
been spared, either by myself or the gentlemen who assisted me, to make it as 
correct as possible; and it is confidently believed that no serious error, or one 
at all affecting the general result, exists. 

" Perhaps the difference between the number of cases of hydrothorax in 
table IX. from that in table X. will most readily attract attention. It is ex- 
plained thus: Ten cases of drojpsy of the heart are in table IX. placed with 
dropsy of the chest, whilst in table X. they are placed more appropriately with 
disease of the organs of circulation. Again, under the head of accidents, 
three are returned in table IX. which in table X. are returned, * killed acci- 
dentally.' Soj also, the gentlemen engaged in making out the tables could not 
always keep in remembrance the distinction between disease of an organ and 
inflammation of that organ, and used one term for table IX. and the other for 
table X. In this way a few errors crept into the report, which were not de- 
tected until the tables were finished, and could not then be corrected without 
referring to the assessors' returns. Again, in classifying those deaths which 
occurred from convulsions, spasms, fits, and epilepsy, some discrepancies in the 
two tables are observed — spasms and fits being rather vaguely divided between 
convulsions and epilepsy. The errors from all these causes, however, are in- 
considerable in number, and much more so in importance. 

"For the better understanding of the subject, the population of each county, 
divided into white and coloured, according to the census of 1850, is introduced. 
It would have been desirable also to have added the population of each county, 
as indicated by the census of 1840, so as to show the relative increase of the 
population of different portions of the State ; but it was thought that, as there 
had been twelve new counties formed since the census of 1840 was taken, and 
as the population of nearly or quite half the counties in the State had been 
materially affected by the formation of these new counties, nothing satisfactory 
or definite could be learned by inserting it. It is therefore not inserted." 

The great amount of labour expended in the preparation of this report from 
the crude materials furnished may be imagined by the fact that the tabular 
statements constitute over one hundred closely printed pages. 

The population of Kentuckv consists of whites and blacks in the proportion 
of about 7 of the first to 2 of the last. In 1850, it was 764,688 whites, and 
220,717 blacks. In his first table, Dr. Sutton shows the number of white 
births, male and female, in each county of the State, as returned by the 
assessors; the number of coloured births, with the sexes; the number of mar- 
riages as returned by the assessors, and also the number of licenses for mar- 
riages issued in each county during the year 1852; the deaths of whites and 
blacks, with the sexes; the proportions of births to the white and coloured 
populations; the proportion of deaths to the whole population, and the average 
ages of the whites and blacks at death. 

" From this table," he observes, " it appears that the white race is something 



160 



BibliograpMcal Notices. 



[July 



more fruitful than the coloured, in the proportion of 1 in 38 to 1 in 40. Whe- 
ther this is real or apparent, is uncertain, as it is thought that, in the enumera- 
tion, births among the blacks would be more apt to be forgotten than among 
the whites. In estimating the proportion of marriages, the number of licenses 
issued has been the basis. Where the clerk of the county has not furnished 
the list, the number returned by the assessor has been substituted. Our laws 
recognize no marriage between the coloured population, though a marriage 
ceremony of some kind is very generally observed among them." 

Marriages. — There were 7,430 marriages reported in the State in 1852, of 
which 5,105 were returned by the assessors. The proportion is 1 to every 
102.92 of the white population. In some counties, the ratio far exceeds that of 
others. In Harrison and Jefferson, the proportions are 1 in 50.34, and 1 in 
54.90 ; whilst in Simpson and Livingston, it was 1 in 239, and 1 in 216. There 
was doubtless some delinquency in making up the returns from the last two 
counties. The order of the months presenting the number of marriages, be- 
ginning with the greatest, is as follows: December, 753; October, November, 
September, March, August, February, January, April, June, July, and May, 
271. 

Of 5,105 marriages, 2,160 females, or 40.30 percent., married under the 20th 
year. The marriages of females under the 25th year, amounted to 80.13 
per cent. 

Of males, 2,669, or 52 per cent., married under the 25th year. 

Births. — Of these, 25,906 are reported for the year 1852, giving a proportion 
of 1 to 38.04 of the population, a ratio sufficiently large to render it unneces- 
sary to make any allowance for defective returns. Arranged so as to present 
the greatest numbers first, the months would stand as follows: December, 
2,698; September, October, November, August, March, May, April, June, 
July, February, January, 1,916. From this statement, it is easy to ascertain 
the months in which the conceptions took place, by reckoning back nine 
months previous. The results would be as follows, beginning with the greatest 
number corresponding with the December births: 1. April; 2, January; 
3. February; 4. March; 5. December; 6. July; 7. September; 8. August; 
9. October; 10. November; 11. June; 12. May. It must be remarked that 
this is the result of only one year's observation, and that no allowance has been 
made for the short months, so as to equalize the proportion due to an equal 
space of time. This has been done by the celebrated statistician Villerm^, of 
Paris, and was followed in a similar investigation made in regard to the births 
in Philadelphia, where the rule adopted was to ascertain for each of the short 
months the average births per day, and multiply this number by ^31. By 
adopting this plan, the monthly Kentucky births and conceptions for 1852, so 
arranged as to show the highest numbers first, would assume an order slightly 
differing from that presented in Dr. Sutton's report : — 



, Births. 

1. December 

2. September 

3. November 

4. October 

5. August 

6. February 

7. March 

8. April 

9. May . 

10. July 

11. January 

12. June 

The months of concep 



including the month made the start 



Excess of Males. 

. 206 
. Ill 
. 181 
. 145 

. 145 
. 154 
. 195 

20 

81 

. 116 
. 112 

7 



Months of Conception. 

April. 

January. 

March. 

February. 

December. 

June. 

July. 

August. 

September. 

November. 

May. 

October. 



ion are obtained by reckoning back nine months, 



ng-point. 



In a short paper published in July, 1848,' upon the "Proportions of the 
' See the American Journal of the Medical Sciences, vol. xxxi. p. 78. 



1854.] Registry of Birthsj MarriageSj and Deaths, in Kentucky. 161 



Sexes at Birth," we endeavoured to assign the causes which operated in 
changing the ratios subsisting between the males and females. We were led 
to this inquiry by an accidental discovery made whilst examining the Phila- 
delphia bills of mortality, namely, that nine months after the prevalence of 
Asiatic Cholera in the city, there was a remarkable diminution in the propor- 
tion of male births — so much so as even to give a preponderance to the females. 
Subsequent investigations of the operation of this and other causes which we 
found operative in determining the^ proportions of the sexes at birth, led us to 
the conclusion that disease, exhausting labour, meagre diet, impure air, intem- 
perance, and other social evils, exert depressing influences which manifest 
themselves in diminishing the proportion of male births, and favouring the 
preponderance of females ; whilst, on the contrary, every agency operating in 
a community to produce and maintain a high state of physical health and 
energy, leads to an increase in the proportion of male births. In many parts 
of Europe, where so many of the people are over-worked and under-fed, the 
excess of male births is very small. Throughout France and Prussia, it is 
usually about six per cent., and in England about five per cent, for the whole 
population. In Philadelphia, the excess of male births is about seven per cent. 
M. Quotelet, of Brussels, distinguished for his statistical investigations, ob- 
serves, in one of his publications: "It is a remarkable, but well-established 
fact, the causes of which are unknown at the present day, that there are 
annually more births of boys than of girls." We have not, as formerly ob- 
served, the presumption to attempt an explanation of the great primary law 
regulating the distribution of the sexes, but at the same time we believe we 
have pointed out causes — somejef which are under human control — which exert 
an efficient agency in determining the proportions of males and females at 
birth in the human race. We believe that all measures tending to promote 
the health and welfare of a population, whilst serving immediately to increase 
its capacities for profitable labour, tend also to promote the multiplication of 
the sex supplying the main physical power. In fact, we regard the increased 
proportion of males over females at birth, as a sure index of the physical ad- 
vantages enjoyed by the population in which the births took place. 

The data embraced in the Kentucky report furnish the strongest evidence 
in support of our conclusions. Fifst, it will be seen that they confirm the view 
thrown out in the paper "On the Medical Statistics of Philadelphia," published 
80 long ago as 1831, that the excess of males at birth, which, in Philadelphia, 
was found to average seven per cent., would, in the more newly settled States, 
be found to exceed that ratio considerably.' This first report of births from a 
Western State, shows an excess of male births exceeding twelve and a half per 
cent, (or 112,52 males to 100 females), being greatest with the black popula- 
tion, in which it reaches nearly fourteen per cent. ! The excess of male births 
is still more remarkable in plurality cases and in the stillborn. Of 230 twins, 
with the sexes designated, 142 are males, and only 88 females, being at the rate 
of 161.36 males to 100 females. Of the stillborn, which constitute 3.09 of ali 
the births, the whole number reported is 785, of which 481 are noted as males, 
and 304 females, making 158,22 males to 100 females. No instance of triplets 
is reported. A case is recorded of a coloured girl, eleven years old, giving 
birth to a child. 

Now, perhaps there is no spot on the face of the earth where more circum- 
stances are combined to favour the highest development of the animal physique 
than that embraced by the limits of Kentucky ; and the well known superior 
stature and physical energy of Kentuckians is proverbial. Here, then, is a 
most striking fact in favour of the positions laid down,^that the excess of males 
over females at birth is increased by every circumstance tending to improve 
the physical condition of a population, whilst, on the contrary, everything 
tending to diminish the standard of physical vigour, tends directly to lessen 
the preponderance of male over female births. The first part of this law having 

' See American Journal of the Medical Sciences for 1831, vol, x. note at p. 120. 
2 In the American Journal of the Medical Sciences, July, 1848, vol. xvi. p. 85. 



162 



BihKograpMcal Notices. 



[July 



been so strongly sustained by the new evidence laid before us, it adds greatly 
to our satisfaction to find equal confirmation of the efiects of the depressing 
forces. 

In running the eye along a column showing the excess of male births for 
each month, we observe this varying from 206 in December to only 7 in June. 
Now, the three months presenting the smallest excess of male births are: 
April, 20; May, 81 ; June, 7 — the corresponding months of conception to which 
are, August, September, and October — the season when the physical forces are 
most depressed by excessive heat of climate and protracted labour, to which 
may be added the malign influences of malaria abounding in many situations 
during the same months, and, in this particular year, a visitation of epidemic 
cholera. Whilst the excess of male conceptions for August, September, and 
November, only amount to 108, those for February, March, and April, rose as 
high as 532. The season furnishing the smallest amount of conceptions also 
shows the smallest excess in the male over the female births. 

To these highly interesting facts deduced from the returns of Kentucky, the 
mass of the population of which we may set down as rural, we are happy to 
be able to add some derived from recent returns made from the general regis- 
tration of births, &c. in Massachusetts. For these, we are indebted to that 
zealous labourer in the field of statistical inquiry, Dr. Edward Jarvis, of Dor- 
chester. Taking the births in several cities and towns in his State, and com- 
paring them with those of the rural population, the result in reference to the 
excess of male over female births is as follows : — 

Males. 

Thirty-five cities and manufacturing towns 30,270 

Rest of the State, embracing mostly the | 
agricultural and rural population J " ' 

From which it appears that of the births in Massachusetts, the excess of 
males over females in the cities and manufacturing towns is about six per cent., 
whilst among the agricultural population it reaches nearly nine per cent. 
This shows a strong contrast with the results of similar computations made 
from data collected among the inhabitants of European countries which we 
regard as subjected to much greater depressing influences than are to be met 
with in any part of our country. But there is even a greater coctrast found 
between the proportions of the sexes born in Massachusetts and Kentucky 
than exists between the ratios observed in Massachusetts and England. In 
the births taking place in the large European cities and manufacturing towns, 
there is no excess of males in those which take place among the most squalid 
poor, whilst the proportion for the general population is only about four per 
cent. Among the rural population of England, the excess of male over female 
births is about six per cent. ; that is to say, the same ratio found in the Massa- 
chusetts cities and manufacturing towns. In Kentucky, the excess of males 
at birth is twelve and a half per cent, of the general population, whilst among 
the coloured portion, representing the poor population, it reaches fourteen per 
cent ! 

Deaths. — The extremely varying ratios in the proportions of deaths to popu- 
lation in many of the counties, can only be explained by great delinquencies 
occurring here and there in collecting information and making out the returns. 
That the proportion of deaths to inhabitants should difier in different parts of 
the State, is a thing to be expected. We have no hesitation in admitting the 
accuracy of the returns from Hickman, Bourbon, Hart, Oldham, and Marshall 
counties, which give the largest mortality, varying from 1 death in 34.22 to 1 
in 43.54 of the population; but we reject at once the returns from Muhlenburg, 
Union, and Jeff"erson, where the deaths reported only make 1 to every 817, 391, 
and 291 of the inhabitants of the respective counties. Every one, at all ac- 
quainted with the nature of statistical investigations, must be aware of the fact 
that numerous errors are to be found in the collections of data from which he 
has to work out his results. But the statistician contents himself with knowing 



Excess of males. 
Females. dumber. Per cent. 

28,594 1,576 5.9 
23,951 2,101 8.7 



1854.] Regutri/ of Births, Marriages, and Deaths, in Kentucky. 163 



that, as a general rule, occasional errors are neutralized by the multiplication of 
observations. Without such considerations, we should often be disposed to 
throw aside publications containing statements with obvious errors, a remark 
.particularly applicable to the reports made at the commencement of almost 
every registration system. Enterprises which have developed into great im- 
portance, have had very faulty beginnings. But time and proper attention 
have gradually brought them to perfection. 

For statistical purposes. Dr. Sutton informs us: — 

" The population of a county has been divided into two classes, the support- 
ing and the supported. In the first class are placed all between 15 and 60 
years ; in the second, all below 15 and over 60 years. Of the mortality in 
Kentucky, 39.39 per cent, belonged to the first class, and 60.61 per cent, to the 
second. In Massachusetts, in 1851, 37.66 belonged to the first class, and 
62.34 per cent, to the second. 

"Of those who died, 6,658 were males; 6,175 were females, and 215 sex un- 
known ; being an excess of 486 males over the females, or 52 per cent, males 
to 48 per cent, females. In Massachusetts, in 1851, the deaths were larger 
among the females in the proportion of 51 to 49 per cent. It will be remem- 
bered that the females preponderate in the population. 

"Of 12,361, whose ages are specified, 4,985 or 40.33 per cent, died under 5 
years of age. This is within 1 per cent, of those dying of the same ages in 
Massachusetts. The proportion of those dying in advanced age is small, and 
yet, 12 (2 white males, 2 white females, 2 black males and 6 black females), 
over 100, are reported. The most advanced age was 110, a white female. In 
Massachusetts, the whole number of centenarians was 5. 

" The month is designated in 12,357 instances, of which the greatest mortali- 
ties occurred in August, 1,805; September, 1,574; July, 1,432; October, 1,205; 
December, November, June, March, April, May, January, and February, which 
last afforded 643. In March, there Avas an excess of females. In May, Feb- 
ruary, and January, the mortality was equal, or nearly so. In August, in 
which the mortality was greatest, the male excess was 163. In July, which 
was the third in mortality, the male excess was 87; whilst in September, the 
second in mortality, it was only 23. 

" By examination, we find that the hand of death lies heavier upon the 
coloured race. They die in greater proportion, and at an earlier age. The 
proportion of deaths is 1 in 65.57, whilst of the whites it is 1 in 76.03. This 
proportion, though greater than that of the whites, is yet greatly less than the 
mortality among the black population of Philadelphia — the only comparison 
which it has been convenient to make. By a paper on the vital statistics of 
Philadelphia, published in the American Journal of Medical Sciences in 1848, 
the average mortality was stated to be, among the black population for ten 
years (from 1820 to 1830), 1 in 21 ; and for ten years from 1830 to 1840, 1 in 
31 — greatest mortality, 1 in 221^ ; least, 1 in 38|." 

*' Again, the tables reveal two facts, which appear somewhat contradictory. 
1. The proportional mortality is small, even allowing what would be thought a 
sufficient latitude for omissions by the assessors. 2. The average age at death 
is low. This may be accounted for if the census should show a large propor- 
tion of very young persons among us. 

" Being desirous to discriminate the relative degrees of mortality, as indicated 
by the registration returns, I thought it advisable to do so in connection with 
the geological formation of the State, as at present understood. For this pur- 
pose, I procured a copy of the map presented by Professor Peter, in his report 
to the Society'-, and have made spots upon it, which, without interfering at all 
with the geological delineations, will, it is hoped, indicate distinctly the rela- 
tive mortality. The diamond-shaped spots, thirty in number, indicate a mor- 
tality of less than, one per cent. ; the triangles, twenty-five in number, indicate 
a mortality of more than one and less than one and a half per cent. ; the 
squares, thirty-four in number, indicate a mortality between one and a half 
and two per cent. ; and the round, ten in number, indicate a mortality over 
two per cent. Meade and Powell counties are not marked, because Meade fur- 



164 



Bibliographical Notices. 



[July 



nished an account of her deaths which it was impossible to understand; and 
Powell having been created since the census of 1850 was taken, nothing is 
known of her population. If her population and mortality are merged with 
the three counties of Clarke, Estill, and Montgomery, from which she was 
formed, the whole group will be characterized by a square/' 

Causes of Death. — In classifying these. Dr. Sutton has adopted the system 
laid down by the American Medical Association : — 

" Of 13,043 deaths reported for the year 1852, 10,411 have the causes assign- 
ed, leaving 2,637 in which the causes are not designated. This, says Dr. Sut- 
ton, being something more than one-fifth of all the deaths, would seem to be a 
large proportion ; yet, when we reflect that it is the starting of our registration, 
and that very many physicians, and the whole mass of the people were igno- 
rant, both as to their duty under the law, and as to what was expected at their 
hands, we ought to be satisfied. 

"In examining table X., we shall be forcibly struck by the fatality occa- 
sioned by class I, Zymotics. This gives a mortality of 56.43 per cent, of all 
ascertained causes of death. This class is large in all countries, but very 
rarely assumes the magnitude here displayed. In Massachusetts, it has ranged 
from 27 to 38 per cent. — the average for 10 years being 30.42 per cent. This 
class contains diseases which it is thought can be very much guarded against 
by proper sanitary regulations, and therefore ought not to be permitted to pro- 
duce such an awful mortality. 

" At the head of the alphabetical list in this class, we have Cholera, which is 
represented by a mortalit}'' of 722, or 6.94 per cent. By running the eye along 
the list of counties, it will be seen that this disease prevailed to any consider- 
able elfect in only a few counties. A few cases of cholera morbus are included 
under this head. 

" Next comes Cholera Infantum, which twenty or thirty years ago was a 
great outlet of infant life. Of late years, the mortality from this cause has 
very much diminished ; but 135 cases, or 1.30 per cent, of deaths, is ascribed 
to it. 

" Croup occupies a more prominent place, having caused 461 deaths, or 4.43 
per cent, of deaths. 

Diarrhoia occupies but little space; but Dysentery stands forth in bold re- 
lief, no less than 1,923, or 18.47^ per cent., having died of it. 

"Of Fever, intermittent, remittent, and continued fever, the last of which con- 
tains typhus and typhoid fevers, we may speak in a group — continued fever 
having produced a greater mortality than any disease, except dysenterj; and 
if we include (what probably enough belong there) all entries under 'fever' 
simply, we have no less than 13.09 per cent, of deaths from all ascertained 
causes. Remittent fever, which includes all entries under the heads of bilious 
fever, congestive fever, and one of yellow fever, gives a mortality of 2.07 
per cent. 

"The fevers above mentioned, with cholera, cholera infantum, diarrhoea, and 
dysentery, constitute the great outlet of life, affording as they do 43.27 per cent, 
of all deaths. It is generally admitted that these diseases are dependent upon 
the same causes, more or less modified ; and further, that these causes are very 
considerably under the control of man. Why, then, should they not be looked 
to and obviated? 

" It is true, that a difi'erence of opinion exists among the best informed 
medical men, as to the cause of these diseases ; but this difierence of opinion, 
so far from inducing us to look upon the subject as inscrutable and unsuscep- 
.tible of demonstration, ought rather to stimulate us to more numerous and 
more exact observation. Surely, the proper elucidation of a subject upon Avhich 
the life and health of so great a number of human beings depend, is worthy of 
a serious, thorough, scrutinizing investigation. It is very generally believed 

' The per cent, of each disease was calculated before the returns from Letcher 
County came in. This slightly increased the per cent, of dysentery, but did not sen- 
sibly affect any other disease. 



1854.] Registry of Births y Marriages, and Deaths, in Kentucky. 165 



that exhalations from decaying animal and vegetable matter, imprudent indul- 
gence in eating, and improper exposure to vicissitudes of weather, have very 
much to do in the production of these diseases. Whilst such is a common con- 
viction, surely the dictates of common prudence would impress us with the 
propriety of avoiding these causes. Every one knows that cholera, cholera 
infantum, and dysentery, are very apt to occur in the latter part of summer, 
especially upon a sudden diminution of temperature during the night, after hot 
I weather. Now continued heat tends to debilitate the digestive powers, A 
sudden chilling of the surface of the body, under these circumstances, adds ;i 
greater burden than the digestive powers can bear, and vomiting, or purging, 
or both, take place. Again : every-one who lives in a section of country where 
typhoid fever prevails, has seen large numbers of a particular family prostrated 
by that fever, whilst the neighbours enjoy good health. It may be true, that 
nothing about the premises appears svfficient to account for the sickness; but 
it is there. Diseases no more appear without a cause than corn grows -i^ ithoufc 
being put in the earth. 

" Investigations as to the causes of diseases are more apt to be instituted and 
prosecuted in thickly settled communities, especially in cities, than in rural 
districts. Such investigations have taken place, and seem satisfactorily to de- 
monstrate, that accumulations of filth, together with an obstruction of venti- 
lation and light, are almost always attended by a great mortality in the shape 
of cholera, fever, dysentery, or some other disease belonging to the Zymotic 
class. 

" We hear much of the filth, sickness, and death of other countries, and sym- 
pathize with the sufferers, but /ondly and as vainly hope that these scenes are 
confined to other lands, and are unknown in our happy country. A better 
acquaintance with existing facts, however, will dispel the illusion, and show us 
that the worst state of things in the old world has perfect parallels among 
us. We will adduce but a single example, yet one which it is hoped will set; 
the matter in a strong light. 

"We have been accustomed to look to Philadelphia and Boston as model 
cities, where everything is kept neat and clean, and where a man might very 
comfortably spend a lifetime. It turns out, however, that even Boston has its 
dark spots. Three portions of Boston are given as points of comparison. In 
the first, ' Beacon Hill,' is high, well drained, by nature, the houses large and 
well ventilated; population 2,054, mortality 1 in 74.71. In the second, 'Black 
Bay,' new made land ; the streets narrow ; sewerage and drainage imperfect ; 
the houses small, built around alleys as well as on streets; population, 5,121, 
two-thirds foreigners ; mortality 1 in 52.07. In the third, including Broad, 
Cove, and Lea streets; built principally upon made land, and have numerous 
blind alleys leading into them ; the streets and alleys are badly drained, and 
crowded with an overflowing population ; a large number of the houses have 
no means of sewerage whatever, and all their refuse, of every description, stag- 
nates about the yard, spreading in every direction poisonous exhalations laden 
with disease and death. A majority of the houses contain several families, 
some of them nine or ten. Even the cellars of the houses are often inhabited ; 
and, in some instances, one cellar leads to another, and this to a third — a sort 
of dungeon — all inhabited by human beings, of both sexes, and of every age. 
The population of these streets is 2,813, of whom 2,738 are foreigners; the 
mortality was 1 in 17.6 of the population — and this was a year remarkable for 
its healthiness; what it would have been in a sickly year, we dare not con- 
jecture I One more word, and I have done. A writer, speaking of this same 
district, says : — 

"* * * 'Human beings, men, women, and children, boys and girls, herd- 
ing together like swine, and like swine wallowing in filth — and worse than 
swine, steeped in vices which we dare not mention — will be seen by any one 
who will visit Burgess Alley, and other localities in Broad street district.' 

" But, probably, it will be replied, that this still is in a distant State — no- 
thing of the kind exists in Kentucky. This may be true; but who knows that 
it is true? How many people in Boston know what these corners contain? 



166 



BihliograpMcal Notices. 



[July 



If it is true that no such things now exist in Kentucky, how long will it 
remain true? These things had a beginning in Boston, and it is possible that 
they have already had a beginning in Louisville. I saw it stated in a paper 
published in that city, that very frequently houses are leased before their 
foundations are laid; that families, upon arriving there, frequently had to 
board a considerable time before they could procure houses to live in. "VVe 
must not expect the people of Louisville to be more disinterested than those of 
other cities. Houses that pay well for the money laid out will be furnished to 
all sorts of tenants, and we shall soon have the poor crowding together to save 
the expense of rent at the risk of health and life. This is the beginning of 
cupidity on one hand and seeming necessity on the other, which lead to the 
creation and occupancy of tenements which prove a snare and a curse to both 
body and soul of those who are tempted to occupy them. Now, before the 
thing is commenced, or at least before it has made much progress, the legis- 
lature should utterly prohibit the erection of such habitations. But it may 
be said that these considerations pertain to large cities, and the great bulk of 
the country have no interest in them. It is replied, that the time is not far 
distant when one-twelfth or even one-tenth part of the population of Kentucky 
will be gathered together in the cities of Louisville and Covington. Again, the 
same principles as to health and disease apply to both city and country; what 
is true of one is true of the other. The principle, and the proper application 
of it, are what we want. 

Scarlet fever did not cause many deaths in 1852 — a fraction more than one 
in each county on an average. Hooping-cough and measles each caused more 
than thrice as many deaths as scarlatina, and about a fair proportion. 

" Milk sickness is now for the first time introduced into a classified table, 
and this seems the most appropriate place for it. Nevertheless, many phy- 
sicians in the West doubt whether it is a distinct disease, or is a modification 
of bilious fever. The present returns show a much less mortality from it than 
was expected. 

" Croup gives as usual a large proportion, 461, or 4.43 per cent, of the mor- 
tality. The other diseases of this class exhibit a small mortality, thrush being 
the greatest in proportion to what would be expected. 

"Class II. Diseases of general or uncertain Seat, composed of a considerable 
number of diseases, gives a small per cent, as a class, being only 5.78 per cent. 
Of this class dropsy produced the greatest mortality, 230 or 2,21 per cent. 
Next comes scrofula, which caused 155 deaths or 1.49 per cent. 

" Class III. Diseases of the Nervous System, gives a small proportion, 6.69 
percent.; inflammation of the brain, 242, and convulsions, 130, being the only 
diseases which cut much figure. Paralysis follows, giving a mortality of 68 
or .65 per cent. Trismus nascentium is introduced, because it is generally be- 
lieved to be a considerable outlet of life, especially among the coloured race. 
The proportion returned under it, however, is very small — only 4 in all. 

" Class IV. Diseases of the Respiratory System, as in all countries, gives a 
considerable mortality ; and, as in other countries, consumption and pneumo- 
nia make up a very large proportion of the whole class. Whilst the whole 
class, 17.27 per cent., and consumption 9.20 per cent., are considerably less 
than an average, in Massachusetts, pneumonia, 5.74, is nearly 1 per cent, 
greater. 

" Class V. Diseases of the Circulatory System, consisting almost entirely of 
diseases of the heart, gives only .68 percent, of deaths; 10 deaths from dropsy 
of the heart are classed in the alphabetical list under ' dropsy of the chest,^ 
and 2 cases of malformation of the heart are included. 

" Class VI. Diseases of the Digestive System, gives a smaller per cent, than 
might have been expected, only 4.34 per cent. Enteritis gives 112 deaths, or 
1.08 per cent. Worms 105, or" 1.01 per cent. No other disease amounting to 
one-half of one per cent. 

"Class VII. Diseases of the Urinary System, is quite small. Gravel, which 
gives Vjut 16 cases, being nearly one-half of the whole class. 

Class VIII. Diseases of the Generative System, gives a rather large com- 



1854.] Registry of Births, Marriages, and Deaths, in Kentuchj. 



187 



parative proportion, 130, or 1.25 per cent. The principal mortality was occa- 
sioned by puerperal fever, 63, or .61 per cent. Childbirth caused 50 deaths, 
or 1 in 517.56 births; perhaps a large proportion. By comparing the deaths 
from this cause it appears that .36 were whites, or 1 in 562 births ; and 14 were 
coloured, or 1 in 387 births. We find that puerperal fever caused 1 death to 
413 births among the whites, whilst it caused just the same number among the 
coloured as childbirth, 1 in 387. 

" Class IX. Diseases of the Locomotive System, caused few deaths — 57 in 
all ; of which 37 were from rheumatism. 

Class X. Diseases of the Integumentary System, gives 15 deaths in all. 

" Class XI. Old age, gives a rather small per cent., 2.35. By referring to 
the alphabetical list of deaths, we find some rather strange entries, viz. 1 death 
under 5 years, and 1 between 5 and 10. It is presumed that the assessor made 
an erroneous entry, either having no ink in his pen when he attempted to 
make a figure, or else making the entry on the wrong line. 

" Class XII. Deaths from External Causes, furnishes about a fair proportion, 
4.20 per cent. This class is a tolerably fair barometer of the carefulness, 
sobriety, and good order of a community. As compared with the report of 
Massachusetts for 1851, the list of accidents, and persons killed accidentally, 
are, together, less than the accidents in that report, as 293 is to 138. Burns 
and scalds furnish a list as 59 is to 78. Drowned is much smaller, as 56 is to 
236. Indeed, it seems strange that our State, bounded for two-thirds of its 
circumference by the Big Sandy, Ohio, and Mississippi rivers, and intersected 
by the Little Sandy, Licking, Kentucky, Salt, Green, Cumberland, and Ten- 
nessee rivers, besides numerous mill-streams, should not furnish a larger list 
from this cause; especially when we consider the great proneness of our 
coloured population to travelling at night. 

"But one person is returned as having been executed. 

"Eight are reported as having been frozen, and, as under old age, we have 
the strangeness of having three of the eight frozen in April, May, and June. 
It is presumed that these errors were made in transcribing the assessor's books, 
by the clerks Intemperance is charged with 28 deaths against 41. Killed by 
design is charged with 31 deaths against 6 murdered in Massachusetts. It 
may be well to remark, that in this table all the killed are set down as acci- 
dentally done, except from one county, in which a deadly feud was known to 
exist between two families, which feud was known to have caused several 
deaths during the year ; all the killed in this county, amounting to 5, are pre- 
sumed to have been killed by design. 

'* It must be acknowledged this list of killed by design, 31, looks badly for 
an orderly people. It proves very conclusively that the people of our State 
have not that control over their passions which rational Christian people ought 
to exert. Admitting that a large majority of these homicides were in self de- 
fence, it yet proves that there is a very unfortunate spirit of aggression in the 
land, which alone could have warranted the taking of so many lives. The 
suffocated, which includes smothered and strangled, seems to be greater in 
number than should be. The same is true of the poisoned; whilst the suicides 
were small in number. 

"The object of this Classified Table is to show the number who died of 
each particular disease, in each county in the State, without reference to colour, 
sex, or age. But the Alphabetical List is intended to exhibit the mortality 
of each colour, sex, and age, throughout the State, from each disease, and the 
month during which those deaths took ph.ce. 

" To Kentucky belongs the credit of having first instituted a series of ob- 
servations upon a large scale, the object of which is to ascertain the relative 
healthfulness, fecundity, and longevity of the white and of the coloured popu- 
lation. Nothing can be inferred from the returns of a single year, especially 
when that year is the very beginning of observations ; but the anticipation is 
now hazarded, that, when observations shall have been sufiiciently numerous 
and long continued to authorize the formation of a judgment, it will be found 
that, so far as health and longecity are concerned, the slaves in the slaveholding 



168 



BihliograpJiical Notices. 



[July 



States are in a better condition than that class of any nation which is nearest 
assimilated to them in social position. 

" Even if it were allowable to draw conclusions from a single year's expe- 
rience, time at present does not permit any extended analysis. Yet it may be 
permitted, as a means of directing attention to the subject, to advert to the 
great proportional mortality among the coloured race from certain causes, as 
convulsions, tetanus, worms, burns, and scalds ; whilst there are other causes 
affecting the whites to a proportionally great degree, among which stand out 
in bold relief, dysentery and ' killed/ '^ G. E. 



Art. XIII. Lectures on the Diseases of Infancy and Childhood. By Charles 
West, M. D., Fellow of the Royal College of Physicians, Physician to the 
Hospital of Sick Children, Physician-Accoucheur to, and Lecturer on Mid- 
wifery at, Saint Bartholomew's Hospital. Second American from the second 
and enlarged London edition. Philadelphia: Blanchard & Lea, 1854. 8vo. 
pp. 486. 

The high estimate of these lectures, formed and expressed by us upon their 
first appearance in 1848, is in no degree diminished after an attentive perusal 
of the second and enlarged edition now before us. 

The views laid down in relation to the pathology and therapeutics of the 
diseases, embraced in the lectures of Dr. West, being based mainly upon his 
own observations, carefully collected during a series of years, in an ample and 
favourable field for the clinical investigation of the leading maladies incident 
to the period of infancy and childhood, render the volume before us one of 
great value to the student and practitioner. 

In the preparation of this second edition, the entire work bears the evidence 
of having undergone a careful revision, while numerous additions, the result of 
the author's more extended investigations, and more careful reflections, have 
been made to several portions of it. 

The work now comprises the results of 640 observations, and 199 post-mortem 
examinations, chiefly made among 16,276 patients who came under the author's 
notice during the ten years of his connection with the Children's Infirmary in 
Lambeth. 

The lectures of Dr. West devoted to the consideration of the afiections of 
the respiratory organs, as they occur during infancy and childhood, are par- 
ticularly excellent. They furnish a clear, satisfactory, and able exposition of 
the symptomatology, pathology, and therapeutics of those frequent and too 
often fatal maladies of the earlier years of existence, and are deserving of an 
attentive study on the part not merely of the medical pupil, but of the prac- 
titioner also. The directions for the treatment of croup, we would especially 
urge upon the attention of the junior members of the profession, but, at the 
same time, with the sensible caution with which the lecturer premises his 
examination into the pathology of that disease. 

"With reference," he remarks, "to many of the more important points in 
the history of the malady, writers are now, indeed, pretty well agreed ; but 
croup, like many other diseases that depend to a great degree on atmospheric 
and telluric causes, is modified in many of its symptoms by peculiarities of air, 
• water, and situation. The affection assumes one character among the poor of 
a crowded city, and another among the children of the labourer in some rural 
district. If, therefore, you find that my account of the disease varies in any 
respect from the description given by some other writers, or from the results 
of your own observation hereafter, do not too hastily assume either that your 
teacher has been mistaken, or that your own observation has been incorrect. 
The difference may be nothing more than a fresh exemplification of the old 
story of the shield ; silver on the one side, and golden on the other, about which 
the knights in the fable quarrelled." 



1854.] Stokes, Diseases of the Heart and Aorta. 169 



This admonition might, with grocat propriety, be repeated in reference to 
other of the diseases of early life besides croup. 

The several diseases in the portion of Dr. SVest's lectures just referred to 
have evidently held a prominent place in the clinical investigations of the 
author. The thirteen lectures devoted to their consideration occupy 156 pages, 
or over one-third of the entire volume. 

The affections of the brain and nervous system that ordinarily occur during 
infancy and childhood are, also, abl}^ treated by Dr. West. We could have 
desired, it is true, a somewhat more detailed investigation of some of the points 
connected with their pathology than that given by the author. There is no 
class of the diseases of early life in relation to the true character of which the 
inexperienced practitioner is more liable to be deceived — none in reference to 
which a close attention to the value of particular phenomena is of greater im- 
portance. 

The eleven lectures on the diseases of the brain and nervous system occupy 
120 pages, or about one-fourth of the entire volume. 

The account given by the lecturer of the diseases of the heart, and of the 
urinary organs, of the acute and chronic forms of peritonitis, and the fevers, 
including smallpox, chicken-pox, measles, and scarlatina, are in general full 
and satisfactory. 

The lecturer's account of the diseases of the digestive organs of children, are, 
perhaps, the least satisfactory of any in the course. We find no particular fault 
with the views advanced in relation to the pathology of these affections, and 
agree with him in the general outlines of the course of treatment he lays down; 
but there are many points of importance in relation both to their pathology and 
management he has scarcely touched upon, of which a more detailed exposition 
would seem desirable to the student and young practitioner. 

Upon the whole, however. Dr. West has ably executed his task. Comprising 
the results of extensive personal experience and matured reflection on the part 
of, evidently, an acute and cautious observer, his lectures have that degree of 
interest and of authority which strongly press them upon our attention. They 
already constitute a standard work of reference on the diseases of which they 
treat: while, from the enlarged and still more favourable opportunity for clini- 
cal observation afforded the author, by his appointment as one of the Phy- 
sicians to the London Hospital for Sick Children, and his earnest devotion to 
the cultivation of medical knowledge, we anticipate, as renewed editions of the 
work shall be demanded, to derive, through its pages, a still more intimate 
acquaintance with the several maladies of early life, and with the means best 
adapted to conduct them to a favourable termination. D. F. C. 



Art. XIV. — The Diseases of the Heart and the Aorta. By William Stokes, 
Regius Professor of Physic in the University of Dublin, Author of " The Treat- 
ment and Diagnosis of the Diseases of the Chest," &c. Philadelphia: Lindsay 
& Biakiston, 1854. 8vo. pp. 689. 

A WORK embodying the results of the author's clinical observations, " con- 
tinued almost unceasingly for upwards of a quarter of a century," can hardly 
fail of attracting attention ; but when it is remembered that this author is Dr. 
William Stokes, and that this long experience is that of one whose medical 
perception, veracity, and skill, have placed him in the highest seat in the British 
School of Medicine, we should be grateful that the profession can still profit by 
his instruction, and humanity by his labours. We would fain dwell upon the 
personal traits of our distinguished author, although in these the medical public 
are not directly interested ; yet we cannot avoid thinking that the personal 
character of a man has much to do with the confidence we should award to his 
written opinions. Who, then, that has been privileged to listen to his teachings, 



170 



BihliograpMcal Notices. 



[July 



and enjoy his social intercourse, that will not bear willing and enthusiastic wit- 
ness to his noble qualities. Affection, admiration, and respect, are the ready- 
tribute to those rare excellences of heart and head, to those native graces of 
temper, and acquired treasures of wisdom, by which so many have been de- 
lighted, taught, and enriched. His book is a reflection of himself. Truth 
without pretension, firmness without dogmatism, originality without affectation, 
are found upon every page, and give value to every precept. The true object 
of the healing art is not lost sight of in the minute handling of merely curious 
details, or in scientific abstractions. The author, himself thoroughly learned 
in physical diagnosis, does not disdain to acknowledge the short-comings of this 
mode of investigation. The safety and cure of his patient is the object which 
he keeps constantly before him ; disease, he describes as he finds it at the bed- 
side, and not as it is abstractly when divested of its attendant complications. 
He says: "The diagnosis of the combinations of diseases, even in so small an 
organ as the heart, is still to be worked out; and, until this be done, the rules 
of physical diagnosis founded on the presumed isolation of disease, must be used 
with great caution. I cannot, even at the risk of being charged with under- 
rating the position of physical investigation at the present day, avoid express- 
ing my opinion, that a too great positiveness marks some of the statements in 
our standard Avorks, and that the difficulties of special diagnosis are still in- 
finitely greater than many might be led to believe." 

We propose, in the following pages, to give the reader a general notion of the 
contents of this treatise, premising, however, that any notice, however full, can 
give but an insuflicient idea of a work, one of whose chief merits lies in its con- 
densation. 

Inflammation of the Heart and its Memhranes , is the subject of the first chapter. 
Pericarditis, naturally, occupies the first place, since the occurrence of either 
carditis or endocarditis separately, without the pericardium being involved, is 
rare and exceptional. It is considered under two aspects, first, in combination 
with general or local disease (except that of the substance or lining membrane 
of the heart), and secondly, as complicated either with rheumatic, intermittent, 
or typhus fever, gout, phlebitis, or dropsy ; or again, when the disease is of a 
local character, with typhoid inflammations, fatty degeneration, chronic hyper- 
trophy, and ulcerative perforation. In the diagnosis of pericarditis. Dr. Stokfes 
naturally places more reliance upon physical investigation, than on the general 
symptoms of the disease, these being very inconstant in their character. Peri- 
carditis, he says, is one of the most frequent of the unrecognized and often 
harmless diseases which afl^'ect the human body, but, at the same time, it may be 
both latent and dangerous. In those cases where the danger is not revealed by 
the functional signs, and which are complicated with rheumatism, Dr. Stokes 
says (p. 47), "That though the combination of pericarditis with acute articular 
rheumatism is common, yet, that the disease of the heart is more closely related 
to the rheumatic fever than to the inflammation of the joints;" and "every 
variety and degree of pericarditis may occur in connection with acute rheuma- 
tism, from the simple, di^y, latent pericarditis, to the worst forms, combined 
with inflammation of the endocardium and muscular structure." In his account 
of the general symptoms of this disease, Dr. S. dwells upon the difi'erence be- 
tween the oppression of breathing in pericarditis and in pleuritic effusions. The 
tolerance of great effusion is much less in the former disease, and is not acquired, 
as it is in pleurisy or empyema. His clinical experiments upon the pulse, es- 
tablish that no special condition of the pulse can be distinguished as belonging 
to any one form or stage of the affection. The physical signs are discussed with 
great perspicuity, and the practical importance of keeping in mind the varying 
pathological conditions upon which they depend, is made very apparent to the 
reader. Thus, although the first stage of pericarditis may be unattended with 
the friction signs, yet this stage is of short duration ; and, if the disease be mild 
and simple, its discovery in the first stage is of comparatively little importance; 
while, if the disease be of a violent and dangerous kind, it will be indicated by 
symptoms. The absence of friction signs, in the early stages is, however, no 
indication of the safety uf the patient, since several days may elapse before they 



1854.] 



StokeSj Diseases of the Heart and Aorta. 



171 



appear. We cannot follow the author in his discussion of these signs, their 
causes, and physical characters. In reference to the error sometimes made, in 
vrhich the signs of pericarditis have been mistaken for those of diseased valves, 
he says: "Their sudden supervention in a case where they had never before 
existed, the accompanying sign (when present) of the rubbing sensation com- 
municated to the hand, the rapid change of situation, the equally rapid modi- 
fication by treatment, and the occurrence of the signs with both sounds of the 
heart, in a case which previously presented no evidence of organic disease, form 
a combination of circumstances which can hardly mislead." Dr. S. also refers 
at length to the modification of the friction sounds produced by the presence of 
air in the pericardium, derived either from the stomach or lungs by fistulous 
communication. In a case related, he found "a mixture of the various attri- 
tion murmurs, with a large crepitating and gurgling sound, while to all these 
phenomena was added a distinct metallic character.'^ The extraordinary loud- 
ness and singularity of the sounds was such that the patient and his wife, who 
occupied the same apartment, were unable to obtain a moment's repose. This 
case, Dr. Stokes considers to have been one of pure pneumo-pericarditis. Ob- 
literation of the pericardium by adhesion of its surfaces after inflammation, does 
not, according to the author's experience, entail upon the heart serious diseases. 
Hypertrophy and dilatation, do not necessarily, or even commonly follow it; he 
says: "I have often found the heart in a perfectly natural condition with the 
exception of an obliterated pericardium." 

Treatment. — Dr. Stokes is not an advocate of an indiscriminate or too active 
antiphlogistic treatment in pericarditis. He thinks that the possibility of weak- 
ening the general system and tlie muscles of the heart, is too often overlooked, 
and that too free and repeated bloodlettings are unnecessary and dangerous. 
While the impulse of the heart continues vigorous, the danger is indeed remote ; 
but weakness of the heart, like that of the diaphragm and intercostals in pleu- 
risy, may supervene in a sudden manner. " In pericarditis, this accident is of 
great danger, threatening paralysis of an organ which is the fountain of life." 
The author places his chief reliance on local depletion by means of leeches, put 
on in relays, and alternated with the*application of warm poultices, and aided 
by the administration of calomel in doses of from ten to twenty grains. This 
mode of giving mercurials, which is particularly recommended by Dr. Graves, 
should be continued until the violence of the inflammation has abated. Stimu- 
lants are, he thinks, often absolutely required, after the first violence of the 
disease has been subdued. Among the indications for their use are feebleness, 
intermittence, and irregularity of the pulse, and the general evidences of a 
weakened circulation. Dr. S. says nothing of any special treatment in rheu- 
matic pericarditis. 

Endocarditis, which is more frequently found in combination with pericarditis 
than isokited, is, according to our author, less frequently met with in rheumatic 
fever than the latter. "Its diagnosis depends on the recent production of a 
valvular murmur, under circumstances indicative of cardiac irritation, or the 
existence of special morbid states of the system, which predisposes to inflamma- 
tion of the heart." He is far from being willing to attribute all valvular lesions 
to this cause, since organic changes affecting the integrity of the valves may 
spring from an infinite variety of sources, independent of inflammation. "In 
practice, the disease may be considered in the following forms, which are given 
in the order of their frequency. First, it may accompany, follow, or precede 
an attack of pericarditis. Secondly, as occurring without pericarditis, when it 
is in general rhanifestfed by symptoms of cardiac irritation, with signs of re- 
cently formed valvular disease. The absence of pericarditic signs may be owing 
to the actual want of any peripheral irritation, or to the obliteration of the sac 
by previous disease. Thirdly, we find that, without any symptom which would 
lead to the suspicion that the heart was diseased, endocarditis may be insidi- 
ously and silently developed in the course of rheumatic fever. Fourthly, symp- 
toms of irritation of the heart may occur in a case where the organ has been 
previously diseased. These may be shown either by an increase in the violence 
of the old, or in the production of new symptoms ; or lastly, by making manifest 



.172 



BibliograpJiical Notices. 



[July 



the signs of former organic disease, which, up to the period in question, had 
been unrecognized or wanting. Fifthly, symptoms of cardiac irritation may be 
deve^ped, unattended by any evidence of valvular lesion. This form is of rare 
occurrence, and I put it forward with diffidence ; but, I have seerj cases which 
could not be explained upon any hypothesis, except that of the absence of mur- 
mur in endocarditis." 

Diseases of the Valves of iJie Heart. — The analysis of the contents of this 
chapter would lead us far beyond our limits. There is no branch of his 
subject which the author has treated with more ability and earnestness, nor 
which presents so many features to arrest the attention and interest and in- 
struct the mind. While avoiding, as much as possible, the discussion of 
purely theoretical questions relative to the mode of production of the sounds 
of the heart, he does not hesitate to communicate freely his own impressions. 
He seems impatient, however, to break away from the discussion of abstract 
questions, and gain from experience all the results he can to enlighten the 
dark points of cardiac pathology. He endeavours to affix a practical value 
upon the alterations of the sounds, reducing them to exponents of the vital 
and mechanical condition of the whole organ. In these are found " the key 
of cardiac pathology; for no matter what the nffection maybe, its symptoms 
mainly depend on the strength or weakness, the irritability or paralysis, the 
anatomical health or disease, of the cardiac muscles." " It too often happens, 
when the existence of a valvular disease is determined, that great labour is 
expended in ascertaining the exact nature and seat of the affection. Long 
and careful examinations are made, to determine whether the disease exists 
at the right or left side of the heart; whether it be a lesion of the mitral, 
tricuspid, or the semilunar valves; a contraction or dilatation; an ossifica- 
tion ; a permanent potency or warty excrescence. Now, though in some, we 
might say in many cases, these questions may be resolved with considerable 
accuracy, it is also true that in a large number their determination is of com- 
paratively trifling importance ; and the two great practical points to be at- 
tended to are, first, whether the murmurs really proceed from an organic 
cause, and next, what is the vital and 'physical condition of the muscular 
portions of the heart ; for it is upon these points that prognosis and treat- 
ment must entirely depend." Dr. Stokes furnishes at the end of this chapter 
a very complete " recapitulation" of the important points discussed or esta- 
blished in it; and, in an appendix, gives in full, the views of Skoda as to the 
causes of the sounds of the heart, since they agree to a certain extent with 
his own. 

Diseases of tlie Muscular Structures of the Heart. — We pass over the pages 
devoted to a consideration of the simple and complicated dilatation of the 
heart to arrive at the chapter on fait]/ degeneration, which is one of the most 
instructive, interesting, and complete in the work. This disease is divided by 
Dr. Stokes into two forms, in the first of which fat is found under the sub- 
serous cellular tissue, and envelops the heart, and in the second the true 
muscular structure of the heart is converted partly or wholly into adipose 
matter. The distinction between the two forms is not considered as rigorous, 
since the last described may ensue upon the first, and, in a practical point of 
view, the history and general symptoms are much the same. When, how- 
ever, the, disease exists to such an extent that but little of the muscular 
structure remains, rupture of the heart is more likely to occur. In addition 
to this fatty transformation, in some cases, free oil is observed in the blood, 
and also in the liver and bony structures; a fact of some importance, per- 
haps, in connection with the theory of the origin of the disease, and, perhaps, 
also with those cases of unusual inflammability of the body which have 
given rise to the notion of spontaneous combustion. This circumstance has 
received particular attention from Professor Smith, of Dublin, who has made 
also some valuable observations upon the development of air in the veins 
before death and after it, but previous to putrefaction. These observations 
have been confirmed by Dr. Stokes. 

The general diagnosis of fatty degeneration is founded upon the signs of a- 



i 



1854.] Stokes, Diseases of the Heart and Aorta. 173 

weakened heart, the occurrence of attacks of pseudo-apoplexy, and a pecu- 
liarity in the respiration appearing to depend upon a deficiency of power in 
the right ventricle. Of these symptoms the last two are the most interesting. 
Those referable tn the brain are explained by Dr. Stokes to consist in attacks 
somewhat resembling those of apoplexy, but differing also from them in the 
frequency of their repetition, the rarity of paralysis, and the fact of danger 
from antiphlogistics and benefit from the use of stimulants. The attacks are 
sometimes apparently purely syncopal, but in the more decided cases are pre- 
ceded by lethargy, loss of memory, and attended by sudden coma. The pecu- 
liar sighing respiration, which the author next describes, he says that he has 
never seen except in this disease. " It consists in the occurrence of a series 
of inspirations, increasing to a maximum, and then declining in force and 
length until a state of apparent apnoea is established. In this condition, the 
patient may remain for such a length of time as to make his attendants 
believe that he is dead, when a low inspiration, followed by one more decided, 
marks the commencement of a new ascending and then descending series 
of inspirations,^^ Coexistence of a certain amount of alteration of the aortic 
valves is common, although not uniform, so that the combination of the slow- 
pulse, a feeble impulse, and a diminished first sound over the left ventricle, 
attended with a single murmur while the second sound remains clear, will be 
sufficient for the diagnosis of the disease in many cases. An excellent and 
slightly philosophical chapter on the treatm.ent of the organic diseases of the 
heart comes next in order. No one can fail to derive benefit from its perusal. 
Our author's observations upon "the condition of the heart in typhus fever," 
and upon "displacement of-the heart,'^ are so familiar to most of our readers, 
that it is not necessary for us to do more than mention the fact that the re- 
sults of them are here introduced in full. 

Deranged Action o f the Heart. — The nervous diseases of the heart are divided 
into those which appear to be simply nervous, and those in which there is 
some structural disease. Dr. Stokes thinks that angina pectoris has probably 
never occurred in a heart free from organic disease. He does not, therefore, 
regard it as a purely nervous affection, but says that it is usually found con- 
nected with some form of weakened heart. Obstruction of the coronary 
arteries as a cause of angina, he considers not effective except, perhaps, re- 
motely, by inducing atroph}' with farty degeneration. The author's remarks 
upon the various forms of nervous disturbance of the heart, as occurring in 
aniEmia, hysteria, gout, and induced by derangement of the stomach, or the 
use of narcotics, close his account of the diseases of the heart. 

Aneurism of the Thoracic Aorta. — Dr. Stokes denies that there are any une- 
quivocal physical signs of this disease. He says that, as a general rule, the 
sounds are more and more similar to those of the heart, according as the 
seat of the disease is near the origin of th.e aorta, but " there are no proper 
signs by which the pulsations of an aneurism within the chest can be distin- 
guished from those of the heart — none deserving the name of unequivocal." 
The diagnosis often depends upon making out two centres of pulsation, in con- 
nection with other acoustic signs. Aneurismal sounds are divided into those 
attended with murmur and those in which there is none whatever. Respecting 
the cause of this variation. Dr. Stokes says, that nothing that can be considered 
exact is yet known, but the certainty of the frequent absence of murmur in 
undoubted thoracic aneurism is attested by his own experience. He says, how- 
ever, that the absence of murmur is not explained by the freedom of the aneu- 
rismal sac from compression, nor is it due to the absence of disease of the aortic 
valves. Cases illustrative of these opinions are given. The general and func- 
tional evidence of the existence of aneurism of the chest and its diagnosis from 
other intra-thoracic tumours are fully considered. It is in such discussions 
that the wonderful clinical diagnostic talent of the author is conspicuous; one 
cannot too much admire the skill and perspicuity with which the most com- 
plicated set of symptoms and physical signs is analyzed and explained. 

It is needless to follow tHe author in his examination of the pathology and 
treatment of this disease and of abdominal aneurism ; a consideration of which, ^ 
founded chiefly upon Dr. Beatty's case, closes the yolume. A treatise like this, 
jS^o. LY.— July 185-i. 12 



174 



Bihliograjphical Notices. 



[July 



replete with facts, observations and important opinions,. upon a subject which 
has occupied the most acute and practised minds in the profession, can hardly 
need the imperfect indication of its value which we have given, but which, we 
nevertheless hope, will induce many to consult it, who may desire a reliable 
guide in the study of the diseases of the heart and aorta. 

M. S. 



Art. XT. — Practical Observations on Gout and its Complications, and on tlie 
Treatment of Joints stiffened hy Gouty Deposits. By T. Spexcer Wells, Fel- 
low of the Koyal College of Surgeons of England, Member of the Royal Insti- 
tution of Great Britain, of the Pathological and Epidemiological Societies, &c., 
late Assistant Surgeon in Malta Hospital. London : 1854. 12mo. pp. 288. 

In this short treatise, Mr. Wells has presented a very sensible sketch of the 
pathology and treatment of gout, and its most frequent complications. Al- 
though the main object of the author is to direct attention to the iodide of 
potassium as a remedy exerting a direct chemical action on gouty deposits, 
and hence, one calculated to restore to their former healthy condition those 
tissues of the body that have become the seat of such deposits, the work will 
be found to contain many interesting hints in reference to the nature and cause 
of gout; the manner in which it is modified by rheumatism and syphilis; the 
several varieties of internal or latent gout; the forms under which the disease 
manifests itself in the female; and the habits, diet, exercises, climates, and 
remedies adapted to prevent, mitigate, or cure the disease, and to remove its 
usual sequelae. 

Gout, the author refers to morbid chemical changes produced in the blood 
by derangement of the process of nutrition ; in consequence of which changes 
certain substances are formed in the blood not found in it in healthy subjects ; 
or, if found, only in very minute portions. To clear the blood of these morbific 
matters, an efi'ort is made for their elimination, in a state of more or less per- 
fect solution, through the ducts of the excretory organs, or by their deposition 

. upon or within the tissues of the joints, or among the interstices of the fibrous 
tissue in whatever part of the body it may be found. 

"In the present state of organic chemistry,^' remarks the author, "the 
exact chemical constitution of the substances found in the blood of gouty per- 
sons, and poured olf from the blood by means of the skin and kidneys, which 
would not be so poured olf in healthy persons (because not existing in the blood 
at all, or only so existing in a minute fractional proportion, there is either no 
possibility of their appearance, or no necessity for their elimination), has not 
l3een accurately ascertained. It has been too common to accept assertions 
which have not been confirmed by trustworthy observations, and the dangerous 
error has been too often committed of making practice accord with theoretical 
views, the truth of which has not been positively established. No chemist, 
known to be experienced in the processes of organic analysis, has made a suffi- 
cient number of careful examinations of the blood and secretions of gouty 
persons, to demonstrate clearly how those fluids depart from their healthy con- 
dition, and in what state their unnatural contents are found in difierent forms 
of gout, and in the same gouty patient at different periods. This is a subject 
which still requires to be worked out by careful, trustworthy and experienced 
chemists, who will assist the medical attendant, and perform for him a duty 
for which his occupations, habits and education but seldom fit him." 

" The chemical characters of the secretions and excretions of gouty patients 
have been more fully investigated than those of the blood itself Still, much 
remains to be accomplished, although the general doctrine may be considered 
as established, that the blood contains certain substances it should not contain, 
that these substances must be either thrown off from the blood in the secretions 
or excretions, or be deposited in or around the joints, or continue to act as a 

' poison in the blood, to circulate with it, and disturb, to a greater or less extent, 



1854.] 



Wells^ Observations on Gouf, etc. 



175 



the performance of the functions of every organ, the physical characters and 
chemical composition of every tissue." 

Microscopical observations have convinced Mr. Wells that the composition 
of the gouty deposits in or around the joints, or in some one of the fibrous tis- 
sues, varies very much in different persons, and in the same person at different 
periods. 

" When," he remarks, " there is general plethora, or an inflammatory tend- 
ency, or vrhen the system is supplied by active digestive organs with super- 
abundant nutriment, lithic acid or the lithates, at times, abound in the urine, 
at others are deficient; and the lithates, with albuminous matter, compose the 
gouty concretions. When, on the other hand, the general health of a gouty 
person has been broken up by long-continued suffering, by mental anxiety, or 
any other depressing cause — when the digestive organs cannot prepare nutri- 
tive matter of good quality, or in sufficient -quantity to supply the wants of the 
system — then the body feeds upon itself; its own half-dead tissues are its food; 
the phosphates form in the urine, and are deposited around the joints." 

As the causes of the derangement of the processes of hjematosis and nutrition 
which give rise to the chemical changes in the blood productive of gout, our 
author enumerates, 1. Hereditary tendency; 2. Undue, or irregular develop- 
ment of the nervous system. 

" AVhen," he remarks, " the brain is irregularly developed, irregularly exer- 
cised — when it isjeft in idleness, more or less complete, for one season of the 
year, and overworked in the other — when the intense study, close attention, 
violent passion, and alternations of excitement and depression inseparably con- 
nected vvith the practice of- gaming, are nightly persisted in — when the very 
composition of the brain is altered from the circulation of blood through it 
which has been but imperfectly oxygenated by the air of crowded public assem- 
blies, it cannot regularly develop nervous power; it cannot regularly distri- 
bute this power throughout the body. The spinal and sympathetic systems 
participate in the disturbance, and the consequence is, that the nutritive and 
absorbent vessels cannot act with precision — their balance is lost — they do not 
deposit or remove what they ought, and the blood becomes charged with super- 
fluous or impure matter, which must be got rid of in some unnatural manner ; 
by undue excretion, or by deposit in some unusual situation. The tissues and 
organs, instead of being renovated and perfected, remain partly composed of 
matter which has been, or ought to have been ' used up,^ and they are conse- 
quently unable to fulfil their several offices in a proper manner. The derange- 
ment of one organ increases that of others. The whole system is deranged, 
and the evil which was the first cause of imperfection and failure, is increased 
by its own effects. Thus, in a continual series of reactions, general alteration 
of the whole blood is produced. Its chemical composition and physical charac- 
ters are altered. Derangement of every part which is dependent upon a 
proper supply of pure blood for perfection, and even vitality, ensues. The 
alteration in the whole of the blood of the body resulting from a loss of balance 
between the nervous and circulating systems not only concurs with other 
causes in producing gout, but I believe it to be an important, if not essential 
element in its production." 

The undue, irregular, or imperfect assimilation of nutriment by the digestive 
organs, in consequence of overfeeding or impropjer food, is the third cause 
enumerated by Mr. Wells as influencing and deranging the processes of nutri- 
tion, and bringing about that abnormal condition of the blood upon which gout 
depends. A fourth cause is, the habitual use of alcoholic drinks, whether 
spirituous, fermented, or vinous. A fifth, the inhalation of a stagnant and im- 
pure air; a sixth, deficient, or irregular muscular exercise : and a seventh, the 
want of attention to the freedom of cutaneous exhalation, from the neglect of 
daily and complete ablution of the entire surface of the body. 

In its general outline, there can be no doubt of the correctness of the patho- 
logy of gout laid down by our author. It is the one, with very slight varia- 
tions, now generally adopted, and which best accords with what we know of 
the character, phenomena, progress, and sequelae of the disease. We cannot 
follow Mr. W. in his explanation of the manner in which the excess of lithic 



176 



BihUograpldcdl Notices. 



[July 



and other acids in blood is produced ; whether the changes of the old tissues 
into urea or lithic acid takes place in the extreme capillaries of the tissues, or 
the excess of acid occurs during the process of the sanguification of food. We 
have, as yet, too limited a series of exact observations and experiments bear- 
ing directly upon this question to enable us to arrive at any satisfactory solu-. 
tion of it. 

In concluding his remarks on the pathology of gout, the author says: — 

"It does not follow because the most marked chemical changes recognized 
in the blood and excretions in gouty persons are those connected with undue 
development of lithic acid, that this development is the only change which 
really takes place, or is the sole result of the operation of the various causes 
which derange the processes of nutrition. On the contrary, it is difficult to 
conceive that such causes can operate, for any length of time, without affecting 
every organ in the body. Whatever may have been the first departure from a 
state of health, so soon as the organs of secretion and excretion are supplied 
with impure blood their functions must be deranged. The kidneys have to 
excrete superfluous nitrogen; they do it for a time, then become incapable of 
doing it completely, and other organs are called upon to compensate or assist 
in its elimination, with more or less disturbance of their own proper functions. 
The liver receives superfluous carbon in the food, and must excrete it, or the 
elimination of carbon by the lungs being interfered with, the liver must com- 
pensate for deficient pulmonary exhalations. It does so for a time, then 
becomes deranged, and the kidneys are called upon to do what the lungs or 
liver ought to have done. They throw off large quantities of carbon in the 
colouring matter of the urine, or in the form of hippuric acid, but they cannot 
do this without derangement of their own proper functions. In the same way, 
when the excretion of nitrogen by the skin is more or less suspended, the kid- 
neys must compensate for the deficient cutaneous elimination. They do so, 
but suffer for it. Thus, whatever may be the primary cause, the general effect 
in the end is the same— an impure state of the blood is produced by the imper- 
fect performance of some of the various processes of nutrition ; the most 
marked, and only distinct impurity hitherto recognized being an undue accu- 
mulation of certain compounds rich in nitrogen. 

" The only nitrogenized substances hitherto known to have been detected, 
are urea and lithic acid, or its compounds; but I am convinced, from observa- 
tion, that these are by no means the only forms in which nitrogen may be 
found in excess, for I have observed, in two cases, that when a few drops of 
the serum of the blood were allowed to evaporate on a piece of glass, and were 
examined under the microscope, that yellowish crystals, neither resembling the 
ordinary salts of the serum nor the lithates, were observed. In one of these 
cases, I was able to obtain about six ounces of blood, in 1849, and my friend 
Dr. Me3^er examined it. He informed me that, on treating the serum with 
alcohol and chloride of zinc, he obtained a precipitate which partly dissolved 
in boiling water, and left, on evaporation, crystals of a highly nitrogenized 
substance, which I have since been convinced must have been kreatine or 
kreatinine. I could detect no similar matter in the urine in that case. It was 
low in specific gravity, varying only from 1010 to 1015, but otherwise normal. 
I have also found that, in some gouty patients, who i^uffer habitually from 
hepatic derangement and hemorrhoids, that carbonized substances abound in 
the blood, and may be detected in the urine in the form of hippuric acid, or 
hippurate of ammonia.'' 

The observations of the author on gout as modified by rheumatism and by 
syphilis, are particularly interesting; they do not admit, however, of a very 
satisfactory analysis. 

In the chapter on the Morbid Anatomy of Gout, Mr. W. presents a number 
of facts and observations which show that in all cases of gout of any duration, 
there takes place a deposit of saline or earthy matter in or upon the fibrous 
tissues — either externally in the neighbourhood of joints, or internally in the 
fibrous envelops of the brain, spinal cord, nerves, and organs of the senses; 
in the fibrous coats of the arteries, and the fibro-serous membranes within and 
around the heart; in the fibrous tissues of the lungs and air-passages; the 



1854.] 



"W ellsj Gliservatlons on Gout, etc. 



177 



aponeuroses of the muscles of the head, chest, and abdomen, and the fibrous 
coat of the testicle ; the lesions resulting from these several deposits giving 
rise to various latent and irregular forms of the disease. 

From the facts that have been accumulated, the author believes the general 
law is established that, as in strong persons certain derangements in the pro- 
cesses of nutrition lead to deposits of the lithates in the fibrous tissues about 
the joints, so in delicate or enfeebled persons, the same derangements lead to 
deposits of the phosphates in the fibrous tissues of internal organs. 

The chapter concludes with some observations on the forms of latent or irre- 
gular gout, depending on the efforts of nature to throw ofi" gouty matter from 
the blood by the kidneys. In these forms of the disease, in some cases the 
kidneys, in others the ureters, bladder, or urethra, are the seat of the most 
prominent symptoms. 

Gout, as it occurs in the female, is the subject of the fifth chapter. The 
various forms in which the disease may be recognized in women are described 
as gouty dvspepsia, gouty hysteria, derangement of the general health leading 
to general and local nervous afi'ections, irritable uterus, leucorrhcea, abor- 
tion, &c. 

The natural treatment of gout, according to Mr. TV., consists in such a regu- 
lation of diet and regimen as shall be adapted to promote the healthy perform- 
ance of all the functions concerned in htematosis, and in the nutrition of the 
system. The beneficial influence of friction of the surface, as means of pro- 
moting the healthful functions of the skin, is pointed out. Of all the forms of 
passive exercise it is, perhaps, the best. 

"Sir William Temple said: ' Xo man need have the gout who can keep a 
slave to rub him/ and perhaps he did not greatly overrate the value of his 
favourite remedy. It was much employed by the ancients, whose attention 
was more directed than ours has been, until very lately, to the development of 
the muscular powers of the body, not only as a means of attaining bodily 
strength and agility, but in order to hasten convalescence after disease, to 
remove stifi'ness following wounds, injuries, or long confinement, and in the 
treatment of various constitutional diseases. But it has been too much ne- 
glected by the moderns, for I am convinced, by observation, that if well per- 
formed, persevered in for a considerable time, and applied systematically over 
the whole body, it may almost be made to supersede the necessity for exercise. 
It leads to very free circulation through the vessels of the skin, and an agree- 
able sensation of warmth which lasts many hours ; and, by equalizing the dis- 
tribution of the blood throughout the body, and leading to free inspiration, 
tends to prevent local congestion and oxygenates the blood. 

Equally beneficial with friction, and, when used in conjunction with it, pro- 
ductive of the most decided advantage in the prevention of gout, is a regular 
course of bathing. It is somewhat remarkable that Mr. W. has, in some de- 
gree, overlooked this in his account of the natural cure of the disease. It is 
true, he tells us that: — 

" The habits of life to be recommended to gouty patients in the intervals 
between attacks, are to rise early, to take a shower-bath, or be rubbed by a wet 
sheet, afterwards by a dry one immediately until warm; then to take some 
gentle exercise in the room by dumb-bells, or any motion of the limbs tending 
to expand the chest, and to drink freely of pure water." 

It is not, however, all constitutions and conditions of health to which the 
shower-bath or cold sponging is adapted. Many of those who are predisposed 
to, or who have already suffered from an attack of gout, will derive far more 
benefit from the daily use of the warm or tepid bath, with friction of the sur- 
face, than from the external use of cold water in whatever way applied. For 
a full and satisfactory exposition of the rules to be observed by the gouty in. 
bathing, we would refer to the very excellent work of Dr. John Bell, of Phila- 
delphia, on baths, and the watery regimen. 

Some judicious remarks are made -by Mr. Wells on the cold water cure in its 
adaptation to gouty patients. 

In the eighth chapter, we are presented with the author's experience as to 
the proper medicinal treatment of gout and its complications. 



178 



Bibliographical Notices. 



[July 



In regard to Needing, he has, he remarks, never seen a gouty patient who 
bore the loss of blood well, but very many who have been injured very seriously 
by it. Purgatives, he believes, are often necessary, but are to be used with 
great caution. In many cases it is absolutely necessary to have the bowels 
cleared from irritating substances, but this must not be done by drastics or. 
saline purgatives. The action of sifdorifics Mr. W. considers to have a most 
powerful curative effect in gout, but it is an action which can, he believes, 
scarcely ever be attained with any certainty by mere medicine. Unless there 
be something in the state of the circulation, or in the condition of the nervous 
system, indicating the propriety of giving antimony or opium, alone or in com- 
bination, he is inclined always to trust to the use of diluents or of external 
measures, as the hot air-bath, or the vapour-bath, to induce perspiration. Some 
very excellent remarks are presented by the author in regard to the use of 
diuretics in gout, as well as on the employment of chemical solvents as pal- 
liatives, while we are endeavouring to remove the state of system on which the 
formation of the abnormal acids in the blood, and the deposits in the tissues 
caused by its presence, depend. 

'* Of all chemical solvents," Dr. Wells states, " I am disposed to regard the 
iodide of potassium as the most useful, it having so great a solvent power on 
the lithate of soda, which is the most common impurity in the blood of gouty 
patients. A concentrated solution of the iodide dissolves the lithate of soda 
very readily out of the body, and to a much greater extent when the lithate is 
recently prepared and the solution is warm ; but it has very little power of dis- 
solving pure lithic acid. I have given it very extensively for the last thirteen 
years in almost all forms of gout, except during the acute attack, and in almost 
every case with the most encouraging results. I have tried it in doses of from 
eight grains three times a day to one grain daily in divided doses. I have had 
patients who have continued the latter small dose for several months, and 
after carefully watching the effects of discontinuing its use and returning to it, 
I have been convinced that the improvement in health which accompanied and 
followed its use, was really connected with, or dependent on, the use of even 
so small a quantity." 

Tonics, according to Mr. W., become occasionally of great use in the latter 
stages of chronic gout. lie speaks very favourably of the citrate of iron and 
quinia, in doses of five grains three times a day, or five grains of the citrate in 
an effervescing draught, with carbonate of ammonia and lemon juice. The 
former preparation he recommends especially in old people, when the action of 
the heart is feeble and irregular. Mineral icaters partake, he remarks, of the 
characters of diuretics and blood depurants, chemical solvents, and tonics, 
some of them having also a purgative action. Colchicum, Mr. W. believes to 
have, unquestionably, a specific power over gout ; it not only relieves the pain 
and inflammation which accompany an acute attack in a joint, but also re- 
moves the symptoms of the disease in other parts of the body. This relief, he 
remarks, is certainly not procured, as many have supposed, in consequence of 
some sensible effect, as vomiting or purging. In the cases in which it is most 
useful, the pain is relieved and the general irritation removed without any 
other perceptible effect. 

" The fear," says Mr. 'W., " that the relief colchicum affords is only obtained 
at the risk of future increase of disease, and of the irregular or internal affec- 
tions of which the gouty eventually die, has doubtless arisen from the use 
of large doses, which really have a most injurious effect by lowering all the 
powers of the system, and is well founded if su(!h doses be given, but is alto- 
gether groundless if the remedy be used in doses small enough to afford relief 
without producing any other effect." By far the best preparation of colchicum, 
according to Mr. W., is a tincture of the flowers. 

The remarks of the author on the application of the general principles laid 
down by him for the treatment of gout to the circumstances present in the 
acute and chronic attacks of the disease—to its various complications with 
rheumatism, syphilis, &c., and to its several internal or irregular forms ; as 
well as his directions for the management of joints stiffened by gouty deposits, 
are concise but judicious, and may be consulted with profit by all who are lia- 



1854.] 



Reports on (lie Health of the British Navy. 



179 



ble to be called to attend upon patients suffering under the disease or from its 
sequelae. 

To the treatise are appended four essays by its author, which appeared 
originally in the Medical Times and Gazette — namely, On the Treatment of 
Ulcers by Galvanism ; On the Cure of Squinting by Prismatic Spectacles; An 
Account of a Ne\y Ophthalmoscope ; and, On the Use of Chloroform Inhalations 
in the Palliative Treatment of Phthisis. D. F. C. 



Art. XVI. — Statistical Eeports on the Health of the Na.vy {British) for the Years 
1837 to 1843, including Seven Years. Part II., East India Station. Presented 
to Parliament, June 1, 1853. Folio, 94 pp. 

As might be inferred from the title, this publication presents a great mass 
of information which will be examined Avith interest by the medical inquirer, 
and more particularly by those of the profession attached to the military and 
naval services. The valuable tables presented show, among other things, the 
total number of cases of all diseases and injuries, specifying those sent to hos- 
pital, invalided and dead, during a series of seven years: the number of cases 
of principal diseases and maladies depending upon specific causes that occurred 
in the different ships; the^otal number of cases of all diseases and injuries 
for seven years, the number sent to hospital, invalided and dead, with the ratio 
of each per 1,000 of mean strength ; the annual mean strength, with the annual 
number of cases of all diseases and injuries ; the total number of cases of the 
principal diseases, the number invalided and dead, with the ratio of each per 
1,000 attacked, for seven years. 

One of the most interesting features of the report is the attempt made to 
reduce practical results from statistics by exhibiting the effects attributable to 
different modes of treatment pursued in different ships. The success was but 
partial, and the attempt was abandoned in consequence of several difficulties, 
among which was that of not finding two or more vessels, in which the men 
liad for a sufficient length of time been placed under circumstances which were 
precisely similar with respect to the influences operating on their health, to- 
gether with all the necessary information as to their exposure on shore or in 
boats, their habits of living, the condition of the decks, modes of ventilation, 
&c. It was, however, ascertained, "that the exhibition of any of the more 
popular remedies on the heroic plan was not attended with the most favourable 
results; for, though when so given they might appear to succeed in one case, 
there were others in which they failed. As in the fevers which prevail on the 
western coast of Africa, where a more rational mode of practice has been in- 
troduced, it was found that bloodletting did not lessen the intensity of morbid 
action, or relieve what has been called congestion; neither did calomel, even 
when ' pushed' to an extravagant extent, arrest the onward course of the ma- 
lady, or prevent the recurrence of febrile paroxj'sms, even though ptyalism had 
been induced." 

The following extracts present condensed statements of the nature and treat- 
ment of the febrile diseases to which the naval and military forces were sub- 
jected during their active service on the Chinese coast in the year 1843. The 
reporter remarks that — 

Like the preceding year, the details for the present furnish the most ample 
proof, were it required, of the unhealthy nature of the Chinese coast from the 
equator up to the thirty-third degree of north latitude; although beyond that, 
even up to the most northern limits of the Yellow Sea, there is no reason to 
suppose that it is more healthy. Everywhere a humid atmosphere overhangs 
a marshy soil, teeming with a profuse and vigorous vegetation, stimulated to 
exuberant growth b}'' strong and offensive manures — conditions which, within 
the tropics, generally, if not universally, prove destructive to the health of 



180 



Biblto'jraj:li iced Notices. 



[July 



men coming from regions north of the fiftieth parallel of latitude. The shores 
and alluvial banks of tidal rivers, on the coast of China, differ in some respects 
from similar localities on the coast of Africa, inasmuch as the former are 
extensively cultivated, and yield their annual produce in obedience to the will 
of man; the latter are still in their natural state, bearing the same wild, 
indigenous vegetation that has covered them for ages, or, it may be, from 
times coeval with the creation of the human race. In both, remitting and 
intermitting fevers prevail; but as regards those which occur in China, there 
is this ditference to be observed, that they are almost invariably accompanied 
by diarrhoeal and dysenteric attacks ; while in Africa, although diarrhceal 
aifections sometimes precede an eruption of fever, they seldom or never as- 
sume a dysenteric character, and they generally cease when the fever becomes 
general, or acquires epidemic force. How far cultivation, and the difference 
in the vegetable produce covering the soil, may be influential in the causation 
of disease in these two regions, is a question which cannot be satisfactorily 
answered. 

" Forty-three vessels were employed for a longer or shorter period on both 
divisions of the station during 1843, with a mean force for the year of about 
6,450 men. 

" With respect to febrile diseases, there occurred, of all kinds, 3,008 cases, 
being in the ratio of 466.3 to the 1,000 of mean force — a considerable reduction 
as compared with the preceding year, yet high as regards the average of a 
series of years, previous to the commencement of the war. There were forty 
deaths, which gives a ratio of 6,1 to the same amount of force, showing that 
these maladies were not only of less frequent occurrence, but that they were 
less fatal. In the medical returns, these 3,008 cases have been placed under 
the heads of intermittent, remittent, continued, typhus, and ephemeral fever, 
distinctions which might lead to the inference that different kinds of fever 
had prevailed throughout the force — but such does not appear to have been 
the case. Originating from causes presumed to be identical on all parts of 
the station, unless the first or second paroxysm proved fatal, they naturally 
presented symptoms which, in the main, were common to them all: as what has 
been called"^ the continued, generally ran into the remittent, and the remittent 
into the intermittent, although there were rare instances in which this order 
was reversed, the two latter apparently, from an increase of morbid action, 
having assumed or passed into the continued type. A large proportion of, 
or rather nearly all, the cases of intermittent were the sequelee of fevers which 
had first appeared in the continued or remitting forms; still there were a few 
cases which seem to have been intermittent from the commencement, although 
it is probable they were connected with preceding attacks, which were not 
observed, or had been forgotten. The term typhus has been applied to twenty 
cases ; it does not appear, however, that they presented the symptoms pecu- 
liarly characteristic of this form of fever, though symptoms usually denomi- 
nated typhoid were noticed: twenty-seven cases of continued and remittent, 
that is, of primary attacks, and twelve of intermittent, terminated in death ; 
the latter were all cases of confirmed ague, which had long resisted every 
kind of medical treatment. 

"Making every allowance for different modes of treatment, the disease ap- 
pears to have prevailed with more severity in some vessels than in others, 
those which were most exposed in unhealthy localities, or in which there ex- 
isted defective hygienic arrangements, presenting the most intractable cases. 
In several vessels, in consequence of secondary attacks, the number of cases 
placed on record far exceeds the number of men borne on the books; the 
Childers and Dido are instances of this kind ; but, in point of fatality, the crew 
of the Cornwallis were the greatest suflerers. In this vessel there were 313 cases 
of intermittent, and 132 of remittent, placed on the sick report during the year: 
by far the greater number of the first-named occurred amongst men who had 
suffered previously, more especially while serving in the Yang-tse-Kiang." 

" With respect to the treatment of these maladies, the surgeon remarks, 'that 
bleeding in the cold stage of intermittent was had recourse to in many instances 
with marked and decided benefit, particularly if this initiatory step were fol- 



1854.] 



Reports on the Health of the British Navy. 



181 



lowed by calomel purges and moderate doses of quinine.' Bleeding was also 
had recourse to in remitting fever, together with nearly all the usual auxiliaries, 
such as cold applications to the head, blisters, calomel purges, the preparations 
of antimony, and, when a remission took place, quinine. Under the exhibition 
of these remedies, the results were not very satisfactory, as eight cases of the 
former and ten of the latter terminated in death. In some instances, it was 
supposed the treatment changed the remitting fever into ague. It is further 
observed, that, ' as compared with the remittent fevers that occurred in the 
Yang-tse-Kiang during the preceding year, these were much more amenable to 
treatment; the remissions being more distinctly marked, quinine could be ad- 
ministered with greater advantage: of the former, there occurred 37 cases and 
4 deaths ; of the latter, 132 and 10 deaths; the mortality for the preceding 
year being nearly a third greater than for the present. But, on the other hand, 
the mortality from all kinds of fever for the present year exceeds that of the 
former in about the proportion of 4 to 2i per cent. It may be fairly doubted 
whether any benefit was derived from the bloodletting; at all events, it could 
only have been of a temporary nature, as the mortality from fever and ague in 
this vessel far exceeded that in other vessels where the treatment was less 
'active,' although the fevers were the same, and contracted in the same as well 
as in similar localities. In estimating the value of any remedy, such, for ex- 
ample, as venesection in the above instance, it seems difficult to conceive how 
its effects could be ascertained separately from those of several other remedies 
which were used at the same time. 

"In the Agincourt, there occurred 14 cases of intermittent, 47 of remittent, 
and 52 of continued or synqchal fever: one of each of the former was invalided, 
and two of the latter died. The most severe cases of remittent were contracted 
at Hong Kong by a party of marines who mounted guard over the same stores 
with the men from the Cornwallis; the earliest appeared on the 9th, and the 
last on the 30th of July. Every man of the guard who slept on shore was 
attacked ; whereas there did not occur, at that period, a single case of a similar 
nature amongst the rest of the crew. Out of 75 men ordered on this special 
duty on the 25th of June, 47 were attacked with fever, and the remaining 28, 
who escaped, suffered severely either from diarrhoea or dysentery. The dis- 
ease was not developed in any instance until after they had been fifteen days 
landed. The remedial measures employed in these cases were emetics at tiie 
outset, then a mercurial purge, and, subsequently, James's powder, saline medi- 
cines to keep the bowels open, and a dilute solution of acetate of ammonia, 
with nitrous ether as common drink. Bleeding was not employed in any 
instance ; but it was thought necessary in many cases to ' push the mercury to 
ptyalism' — a mode of expression which means that it was not given with a 
sparing hand. 

" It is remarkable that in the Cornwallis, in which — ' when high arterial 
action and headache were present' — it was thought necessary to resort to active 
measures, such as bleeding, ' to reduce the disease to a manageable form,' the 
number of deaths from remitting and continued fever, namely, primary attacks, 
was not far from being four times greater than in the Agincourt, in which 
blood appears to have been only once abstracted by leeches?. In making these 
comparisons, it is also at the same time to be borne in mind, that the crew of 
the latter vessel had not completed one year on the station, and had never 
ascended any of the great rivers; whereas the men of the former had been 
upwards of three years actively employed on all parts of the Chinese division 
of the station, and had suffered most severely both in the Canton and in the 
Yang-tse-Kiang rivers; it may, therefore, be readily imagined that they were 
not only less able to withstand the debilitating efi"ects of fever, but less likely 
to be benefited by depletory measures, than were the crew of the newly arrived 
ship, amongst whom it was not considered to be necessary." 

" In July and August, Avhile the solar heat was great, parties of men from 
the Cambrian were occasionally exposed to its influence while watering the 
ship; they were also exposed to the cold night-air and to dews, in consequence 
of the watering-place being at a distance, which required them to be absent all 
night. While thus employed, they took cinchona bark, in spirits, as a propbj- 



182 



Bihliogropliical Notices. 



[July 



lactic, apparently with good effect; for although they were employed floating 
the water-casks to and from the boat during the hottest part of the day, with 
the upper part of their bodies exposed to the full force of a mid-day sun, Avhile 
the lower Avas immersed up to the middle in the sea, yet none of them con- 
tracted any serious illness. The surgeon, indeed, has remarked, that if it were, 
not for liberty to go on shore, together with the intemperate use of spirituous 
liquors, and of solid animal food, such as ' ducks, eggs, hams, pork, and poul- 
try,' the crew would have enjoj^ed an almost perfect immunity from every kind 
of sickness; and he has further stated, that * if inebriation could be prevented, 
there would be little for a medical man to do on a foreign station, and the ships 
would be more effective than is generally the case/ 'I have never,' he adds, 
' seen a more salubrious climate than the climate of this part of the coast of 
China; and I am perfectly satisfied that if alcohol were not in existence, there 
would not be many advocates for malaria' (as a cause of disease). There is a 
certain amount of truth in the preceding remarks as regards the influence of 
intoxicating liquors; but as to the supposed salubriousness of the coast of 
China, there are too many proofs to the contrary. And although intemperance 
was unquestionably, in numerous instances, the primary source of disease, 
still there is no reason to suppose that it was productive of a tithe of the various 
maladies which prevailed universally throughout the naval force employed on 
the Chinese waters. The immoderate use of the several kinds of food men- 
tioned may have had some influence; still there does not appear to have been, 
in this vessel, any increase of those diseases that generally result from reple- 
tion or continued over-eating ; and, as the crew of the Cambrian suffered but 
little compared with the terrible destruction of health and life caused by other 
diseases in vessels in which the men suffered from the want of nutritious ani- 
mal food, it is to be regretted that these good things were not more equally 
distributed to the whole force, whether naval or military." 

May we ask, where, on the shores of the Western Pacific, is to be found that 
terrible scourge of seaports on the Atlantic, the yellow fever. lias it to make 
its way to the Chinese ports, as it has recently done to those of the Southern. 
Atlantic, on the Amazon, and La Plata? 

Among the most formidable maladies Avith which the surgeons had to con- 
tend, were bowel complaints, dysentery, diarrhoea, cholera morbus, and, worst 
of all, Asiatic cholera. 

The following passages will afford some interesting details relative to the 
characteristic and mooted points connected with the treatment of the latter 
disease : — 

In the Blonde, while lying at the same anchorage with the Belleisle and 
Cornwallis, near Ching-Kiang-foo, close to the position occupied by the 98th 
regiment, in which the disease raged with destructive force, only one case oc- 
curred. For this exemption the surgeon states it would be difficult to assign a 
cause; he, however, hazards the opinion, 'that )t might depend upon the non- 
depletory plan adopted in the treatment of fevers, which, being of an asthenic 
form, bleeding was contra-indicated.' The physical powers of the men were 
thus, he supposed, better aljle to withstand the inroads of any disease occurring 
subsequently, while they were less susceptible to the variations of temperature. 
This vessel moved from Ching-Kiang-foo up the river to Nanking on the 6th of 
August, and remained there until the 1st of October; she then began to move 
down the river on the morning of the 2d, when five other cases occurred, one 
of which proved fatal. Four of these, being at the time under treatment for 
intermittent fever, were not entered on the sick list for cholera." 
• " Fourteen cases of cholera occurred in the North Star, while she lay at the 
entrance of the Woosung River. The first appeared on the 5th, and the last 
on the 25th of August. Eight of these the surgeon has designated as ' of a 
truly malignant character.' ' At the time the disease made its appearance, the 
ship's company had certainly arduous duties to perform, many of them being 
employed on }3oat service night and day ; yet only two or three of the men 
attacked with the disease in its worst form had been employed on these ser- 
vices.' Bloodletting, he states, appeared to have more or less an excellent 
effect in all ; by this means, reaction in nearly every instance was produced, 



1854] 



Reports on the Health of the British Kavy. 



18S 



and the external heat restored; the surface, in some cases, even at death, was 
preternaturally hot. In one of the worst cases, when the pulse began to get 
contracted and weak, thirty ounces of blood, at the rate of about ten at a time, 
■were abstracted with the most marked effect; generally, however, the reaction 
was but temporary. Now, judging from the results, the advantages gained by 
the above mode of practice seem to have been of a very questionable nature. 
Of the effects of any remedial measure, we can only speak with certainty after 
long experience, by repeatedly contrasting its effects with those of other reme- 
dies ; and likewise by contrasting the results obtained by the exhibition of one 
specific remedy, with the results observed in cases treated without the employ- 
ment of any remedial means whatever. In the few cases of cholera that oc- 
curred in this vessel, nearly the same mode of treatment was adopted, the aim 
being in all to lessen what has been termed congestion ; consequently there 
■were no means of judging howfiir the measures were beneficial or detrimental. 
Out of fourteen cases, or rather, according to the surgeon's report, out of eight 
of a truly spasmodic character, six proved fatal — a rate of mortality, it is to be 
presumed, which effectually precludes the possibility of attributing any bene- 
ficial influence to the depletory plan of treatment. In five of the six fatal cases 
recorded, blood was taken from the arm to the extent of from ten to twenty- 
six ounces; but in no instance, judging from the symptoms detailed, does it 
appear to have afforded the slightest permanent relief; the symptoms did not 
alter, and if they had altered, it would have been difiicult to ascertain to what 
the alteration was due, as hot brandy and water spiced was given both before 
and after the bleeding. In one of the cases, after twelve ounces of blood had 
been taken from the arm, an attempt was made eight hours afterwards to take 
away more ; but ' no blood could be obtained, either from the veins of the arms 
or from the temporal artery;' the pulse was then imperceptible at the wrist, 
'the respiration full and loud,' the features much contracted, ' the face and 
neck of a leaden hue ; the body and lower extremities warm, but the neck and 
arms cold and clammy.' Two hours afterwards the patient expired. 

" It is not necessary further to follow up the detail of these cases ; sufficient 
has been stated to show that the bloodletting had none of the excellent effects 
attributed to it." 

*' On careful perusal of all the medical reports from the squadron, it appears 
that in every vessel employed in the Yang-tse-Kiang, from Woosung to Xan- 
king, between the middle of July and the middle of October, cholera or chole- 
raic diarrhoea broke out, while not a case of either form of the disease appeared 
in vessels employed on other parts of this division of the station, with the ex- 
ception of those which arrived at Chusan from the Yang-tse-Kiang. On the 
Indian division of the station it appeared in vessels touching at Bombay, 
Calcutta, and Singapore, the disease being prevalent in each of those places at 
the time of their visit. 

" How far medical treatment lessened the mortality from this disease, or 
whether it influenced it at all, is a question, if we are to judge by the medical 
reports, that will not be easily answered ! for there were not two medical 
officers in the squadron that agreed as to the same remedial measures; while, 
as a general rule, each considered his own, even although every second or third 
case proved fatal, to ha,ve been attended with some good effect. Another rea- 
son which tends to invest this question with difficulty, is the various degrees of 
severity with which the disease appears in different communities in different 
places, and in similar communities in the same places. In several of the ves- 
sels in the Yang-tse-Kiang, in the Driver, Hazard, Harlequin and Jupiter, for 
instance, the disease could hardly be recognized separately, a few of its lead- 
ing symptoms, such as spasm, and profuse watery evacuations, having been 
merely temporarily, so to speak, engrafted on the already existing cases of 
diarrhoea: while in other vessels, as in the Belleisle, Cornwallis, and North 
Star, it displayed all its worst characters. 

" At the period now under consideration, bloodletting appears to have been 
much in vogue all over India; and hov,-ever contrary to common sense it may 
now appear, still it would be difiicult to prove that it was not in some instances 
attended with benefit, while there are others in which it evidently only hast- 



184 



BlUiograpliical Notices. 



[July 



ened the fatal result, inevitable, perhaps, without it. The state which seems 
to have been most dreaded, and against which this most formidable remedy 
was employed, was congestion — the accumulation of dark blood in some part 
of the body, probably in the large veins of the thoracic and abdominal cavities, 
or in the vessels of the viscera themselves. How it was ascertained that the. 
organs contained in these cavities were really in a congested state has not been 
mentioned ; neither has the nature or the action of the primary cause effecting 
these accumulations or stagnations of the vital fluid been explained, nor as to 
how they gave rise to spasm, the flow of immense quantities of fluid from the 
intestinal canal, and, in the end, to death. The mere mechanical obstruction 
offered by these congestions did not interrupt respiration or the action of the 
heart; neither can we suppose they interfered with the secretion of bile or 
urine; and as none of the tissues of any of the organs, however much they 
may have been loaded with blood, were found after death to be disorganized, 
it is difiicult to imagine why simple congestion should have been feared, and 
equally difficult to imagine how the abstraction of blood could be supposed to 
remove the primary cause effecting the obstruction of the circulation, or (un- 
less by diminishing the quantity) relieve the overburdened organs of their 
surplus blood. The purpose for Avhich blood was abstracted, appears to have 
been to excite reaction ; but, if it really ever had this effect, it seems as if we 
might suppose that the increased force of the arterial current would ■ likewise 
increase for a time the venous congestion, and thus the purposed remedy would 
add to the evil it was intended to remove.'' 

The reliance to be placed in the observations made, and results exhibited in 
the report, may be estimated by the fiict that the English squadron on the 
East India station, for at least ten years previous to 1840, seldom consisted of 
less than ten, or more than eighteen vessels, bearing a yearly average of from 
1,500 to 2,000 men. During the war with China, the forces were increased to 
7,000 and upwards. G. E. 



Art. XVII. — History of the Yellow Fever at Netv Orleans, La., in 1853. By 
E. D. Fenner, M. D., one of the Physicians to the New Orleans Charity 
Hospital, &c. &c. New York: 1854. 8vo. 84 pp. 

When a disease breaks out in any locality, it would appear, at first sight, to 
be a very easy matter to settle the question as to its origin — whether from some 
cause existing in the locality itself, or a materies morbi introduced from with- 
out. And yet we find that, in reference to the occurrence of yellow fever in 
this, as well as in other countries, the question of its domestic origin or importa- 
tion from abroad, is still a subject of much and often angry controversy. This, 
however, we apprehend, arises less from the intricacy and obscurity of the 
question itself, or from the want of sufficient data for its satisfactory solution, 
than from the one-sided view that has been taken of the circumstances connected 
with the several visitations of the disease. It is, unfortunately, too often the 
case that a few badly interpreted facts are seized upon, while others, of even 
greater significance, are either entirely overlooked, or, by a forced construction, 
are made to conform to the conclusions deduced from the incomplete or 
erroneous data that have been first adopted. 

A vessel arrives at one of the wharves of a city from some foreign port — from 
one, perchance, within the yellow fever zone, and within a few days one or 
more of her crew are attacked with the disease, while shortly afterwards nu- 
merous cases occur in individuals residing in the immediate vicinity of the 
spot at which the vessel lies, and perhaps in others more or less remote. With 
many, such facts afford unquestionable evidence of the importation of yellow 
fever, which conclusion is almost invariably that adopted by the community at 
large, who never investigate closely or reason accurately, especially on ques- 
tions relating to the etiology of disease, and whose mind it is always difficult 
to disabuse of any error it may imbibe. 



1854.] Fenner, Yellow Fever at New Orleans, La., in 1853. 185 



The arrival of a vessel from a yellow fever locality, and the subsequent 
occurrence of that disease among her crew, and in those residing in the imme- 
diate vicinity of the wharf at which she lies, are not, of themselves, sufficient 
^to prove the importation of the fever. Upon a closer investigation we shall, 
perhaps, find that the occurrence of disease on board the newly arrived vessel 
took place subsequent to her entrance into a locality where all the causes that 
are acknowledged to be capable of producing yellow fever already exist, and 
where, on other occasions, it has broken out without the presence of any vessel 
from either a healthy or unhealthy port, or the introduction from without of 
any source whatever of infection. It is, therefore, as reasonable to suppose 
that the crew of the vessel contracted the disease after her arrival, from the 
local causes there existing, as that by her means it was introduced amid the 
persons on shore simultaneously or subsequently attacked. 

It will, upon further inquiry, be found, perhaps, that the greater number of 
the persons attacked had no communication, either direct or indirect, with the 
suspected vessel, and were out of reach of any poisonous emanations from her 
hold; while, at the same time, no fact connected with the occurrence of the 
disease countenances the supposition of its having been communicated to them 
by those primarily attacked. 

Carrying the investigation still further, a most important circumstance may, 
peradventure, appear, namely, that new cases of the fever continue to occur in 
the same locality many weeks, if not months, after the removal or departure of 
the vessel to which its origin was attributed; or, perhaps, the still more startling 
face will be discovered of the occurrence of sporadic cases previously to the 
arrival of the suspected shij). 

That in all those portions of the United States where the yellow fever has 
occurred — and the remark may be extended to other countries — there exist 
local causes, sufficient, under particular circumstances, not yet well understood, 
to produce the disease independently of any foreign sources of infection, is a 
fact very generally admitted. In too many instances, the possibility of its 
domestic origin has been too clearly demonstrated to admit of any doubt; and 
in no case in which all the circumstances of its outbreak have been carefully 
investigated, has any valid evidence been discovered to countenance the sup- 
position of the importation of the fever from abroad. 

It is possible, we admit, that the arrival of a foul vessel, or one with damaged 
articles of certain kinds on board, during a season of extreme heat, ma}^ give 
rise to yellow fever. In such a case, however, the disease will be confined 
entirely to the crew of the vessel and those who have direct intercourse with 
her, or to such as reside so near to the wharf at which she lies as to be within 
the influence of the poisonous emanations from her hold, while new cases of 
the fever will cease to occur on shore so soon as she is removed. We cannot 
conceive of the possibility of an epidemic of yellow fever being induced in any 
locality, and there continue to prevail for weeks and months, simply by the 
arrival of an infected vessel. 

That the yellow fever which prevailed during the summer and autumn of 
1853, within a very limited district of this city, was produced by local causes 
alone, is a fact established by the most conclusive evidence; and that the same 
is true in relation to the more wide-spread epidemic which, at the same time, 
ravaged New Orleans and its vicinity. Dr. Fenner has, in our estimation, very 
clearly proved in the work before us. He has, with great industry and can- 
dour, and apparently with the utmost care, investigated all the circumstances 
calculated to throw light upon the origin of the disease in New Orleans, and 
has, we think, very clearly shown that they are adverse to the supposition of 
its importation from abroad, while they indicate with great clearness its de- 
pendence upon causes existing within the city itself. 

It is not our intention to present an outline of the history of the epidemic 
yellow fever of New Orleans of the last year, as given by Dr. Fenner, nor any 
abstract of the evidence he adduces bearing upon the question of its domestic 
origin. We prefer that the reader who feels an interest in the subject should 
study the facts collected by Dr. Fenner in detail, as the best means of enabling 



186 Bihliograj)7iicaI Notices. [July 

him to judge of their relevancy, and of the correctness of the conclusions which 
the autlior deduces from them. 

The character of the facts, and of the deductions the author has made from 
them, will be seen by the following general summary, which appears on page 
72 of the history under consideration. 

" 1. We have shown that, when the pestilence broke out, the condition of 
the city in respect to cleanliness y^^s so bad as to be an object public notoriety. 
Indeed, it was in such a state that, if it had given rise to Egyptian plague 
instead of yellow fever, it should not have surprised any one. The only sur- 
prising thing is, that, with so much filth of all kinds as is always to be found 
in this city, we do not have an epidemic every year. The fact that we do 7wt, 
has even led to the public expression of the strange opinion, that the public 
filth of the city, instead of ori'jinatiny yellow fever, absolutely j9ro^ec<!5 us from 
it in no small degree. 

" 2. We have shown that yellow fever appeared much earlier this year than 
usual, and that thejlrst cases occurred in persons who had been in the city but 
a few days, in one instance six days, and in another thirteen. These were 
unacclimated persons, who had just arrived from Europe, and came over in 
vessels direct from Liverpool and Bremen, without stopping at any place where 
yellow fever was prevailing. 

"3. We have shown that no vessel that arrived from any infected port, 
whether in South America or the West Indies, brought any cases of yellow 
fever ; had any on board them whilst they were here, or gave rise to any cases 
previous to those which must have originated in this city. 

" 4. That within a very few days after the occurrence of the first cases, others 
were seen in dilferent and remote places, having no sort of connection or inter- 
communication that we were able to trace after a careful inquiry. That shortly 
afterwards other cases occurred in still more remote and separate localities, 
under like circumstances. 

"5. We have shown that the disease was the same that prevails here to a 
greater or less extent every year, diifering only in the extraordinary degree of 
its malignancy. 

" G. We have shown that all the varieties of endemic fever which prevail 
throughout the southern country were seen here in the midst of the epidemic 
yellow fever, and they were seen to interchange types just as is observed 
among the fevers of the country.'^ 

To this summary Dr. Fenner appends the following comments: — 

" From these facts 1 am led to the inevitable conclusion, that the disease we 
have been considering originated from local causes existing in this city, aided, 
"by an extraordinary constitution or condition of the atmosphere at the time. 

" I am not prepared to maintain that the putrefying filth which is to be found 
to a great extent in this city at all times, is the sole cause of yellow fever; for, 
if it were, we should certainly have an epidemic here every year — but I do 
believe it is almost a sine cjna nan, and that if it were effectually removed, and 
the whole city well paved, it would effect more towards the prevention of yellow 
fever here than anything that can be devised. This opinion is surely well 
supported by the established facts that yellow fever always hreal^s out and rages 
worst in the unpaved and least improved parts of the city, whilst the ivell paved 
and best built portions generally suffer least from it. 

"It is often stated, and believed by many, that yellow fever always breaks 
out first among the shipping. This is 7iot true, as I have repeatedly demon- 
strated in my previous writings on the subject. It is firmly believed by many 
persons that New Orleans is indebted to its naval intercourse with the West 
Indies, Vera Cruz, or Rio Janeiro, for all the yellow fever that is ever seen here. 
In opposition to this opinion stands the stubborn fact, that this intercourse has 
been continued, with but slight interruption, for half a century past, whilst v.-e 
have only had epidemics of yellow fever on an average of about once in every 
three years. Aad furthermore, I have, upon several occasions, carefully noted 
cases of this disease which were imported from Havana and Vera Cruz, and 
although they were placed in apartments where they v/ere surrounded by per- 



1854.] Fenner, Tdlow Fever at New OrleanSj La., in 1853. 



187 



sons -syho had never had yellow fever, I never knew the disease to be commu- 
nicated in a single instance. 

" The great epidemic of this year certainly broke out first in New Orleans, 
but the peculiar constitution of the atmosphere, upon which I must think it in 
a great measure depended, extended to a greater circumference than was ever 
known before in this region. Still, it had its bounds, and nearly all places 
within those bounds which had local causes of disease capable of generating 
yellow fever, with the aid of this extraordinary constitution of the atmosphere, 
did have it. The range of this yellow fever atmosphere, although so wide, was 
as well defined as the narrow locality in the city of Philadelphia, in which the 
disease originated and was confined last summer.''^ 

We shall notice in this connection the general statement of Dr. Fenner in 
relation to the meteorological condition of New Orleans preceding and during 
the prevalence of yellow fever, and his remarks on the close of the epidemic, 
both of which occur in a previous portion of the history. 

After gi^'ing an abstract of the state of the weather from the register kept 
by Dr. E. H. Barton, of New Orleans, Dr. Fenner remarks : — 

"From this abstract we learn that the winter (of 1852-53) was quite cool 
and dry, but without any very cold weather. I did not see any ice in the open 
gutters of the city. 

"The spring was quite variable; alternately hot and cold, and rather dry. 
Vegetation remarkably backward. 

" From the 12th to the 20th of May the days were very hot, whilst the nights 
■were so cold as to render one or two blankets necessary to comfort. The ther- 
mometer rose to 88°, which^is within one degree of the highest point in July. 
On the 21st there was a sudden change, the weather becoming quite C(dd. 
This continued for two or three days; and it was about this time, as well as I 
have been able to ascertain, that the Jew cases of yelloic fever appeared in 
the city. 

"The summer was hot, though not unusually so. It will be seen that the 
average of the thermometer was above 79°, which some contend is necessary 
for the prevalence of the yellow fever as an epidemic. The summer was like- 
wise quite wet, though not as much so as others in which there was not so much 
yellow fever." 

From this statement it would seem that the combined influence of heat, 
moisture, and filth, are not alone suf&cient to produce an epidemic of yellow 
fever. 

Treating of the decline of the epidemic of 1853, Dr. Fenner remarks: — 

" October 13. The Board of Health announce publicly, that there is now no 
epidemic in the city, and that absentees and strangers may come in with safety. 
This announcement was welcomed with joy, and from this time people rushed 
in from all quarters. A few were attacked after their arrival here, but not 
severely, the malignancy of the fever having been greatly mitigated. 

"I stated, in my memorandum of the 17th September, that I considered the 
epidemic was really over then, although there was no public announcement to 
that effect. My opinion was based, not alone upon the great diminution of 
cases, but also upon the change of type that was visible in the new cases then 
occurring. Fevers of the pernicious, intermittent, and remittent types became 
more common than yellow fever. In fact, the yellow fever type was gradually 
giving place to the remittent and intermittent. This is Avhat always occurs, 
as I have completely demonstrated in my previous writings on the subject. 

" The number of deaths from yellow fever, for the week ending September 17, 
was 221. Now, if we refer to the period when the deaths first got up to a 
similar amount, we shall find that it was the week terminating the 16th of 
July, when the deaths were 201. Thus we have two months as the period 
during which it may be said yellow fever prevailed as an epidemic. This again 
corresponds with the observations of the past. We have more or less yellow 
fever in this city every year, but, after a constant residence here of twelve 
years, I must say that I have never known it prevail to an epidemic extent for a 
longer period than sixty or seventy days J' 

" A popular error, of extensive prevalence and long standing, respecting yel- 



188 



Bihiioffrajjhical Notices. 



[July 



low fever, is, iJiat an epidemic can alone he extinr/^iisJied hi/ frost. I demonstrated 
this error in my histories of the epidemics of 1847 and 1848, and the events of 
the present year fully confirm the correctness of my observations. In 1847, 
the epidemic ceased lon^^ before the appearance of frost, yet sporadic cases 
were seen to a considerable extent to the end of the year. On the present occar 
sion, the disappearance of the epidemic was published by the Board of Health 
on the iSth of October, whilst the ^first frost was announced on the 25th of 
October, and that was onl}'- observed on the outskirts of the city. On the 31st 
there was a much heavier frost, but by this time a large number of persons 
liad returned to the city. It is true that some of them were attacked with the 
fever, as before stated, but the cases were generally mild, and easily managed. 
We shall doubtless continue to see scattering cases till the end of the year. 
The general remote cause of all the endemic fevers seen here, which, in its 
most virulent or powerful state, produces an epidemic of yellow fever, gradually 
undergoes modification in the progress of time; it becomes less virulent or 
powerful, and in proportion to the degree of this change will it produce the 
milder types of fever." " The prevailing fecer cause, which in August Y)ro- 
daced 7/ellow fever m nine-tenths of the cases which occurred, had become so 
much weakened in October as to produce mostly the remiitent and intermittent 
types ; yet the relationship between them Avas still so close, that if the latter 
were not promptly cured, they ultimately presented the worst features of the 
former." 

It is now very general!}' admitted, particularly by the leading American 
physicians who have studied the yellov.' fever under circumstances the best 
adapted to lead to accurate conclusions on the su])ject, that the disease is non- 
contagious — that when a patient affected with it is removed beyond the locality 
where it prevails endemically to a healthy situation, he will not communicate 
the fever to those who surround him. That this is geueraily almost universally 
true in reference to yellow fever is strongly insisted upon by Dr. Fenner — and. 
yet we find him making the following unaccountable admission: — 

" I am not prepared to maintain that yellow fever is never communicated, 
per se, from person to person. On the contrary, I can readily conceive that, 
like cholera, typhus, and dysentery, it may sometimes display infectious or 
contagious properties to a limited extent. I have never seen an instance of the 
kind; but cases have been reported to me, upon such reliable testimony, that I 
could see no other way of accounting for them than direct communication." 

" Again," says Dr. F., "yellow fever may be contracted in an infected dis- 
trict, and conveyed in the person of the sufferer to a place quite remote." 

Now we find, in the history which Dr. F. has given us of the epidemic which 
prevailed in New Orleans and its neighbourhood, during the summer and 
autumn of 1853, no facts to warrant the foregoing admissions, which are, also, 
in direct opposition to the experience of those who have carefully observed the 
disease in other epidemics occurring in other localities. It is true. Dr. F. 
endeavours to weaken the force of his admissions by showing that the conta- 
giousness of yellow fever is a rare and accidental concomitant of the disease. 
"Admitting it as true," he remarks, " that yellow fever is capable of regene- 
rating itself in the bodies of the sick, and of thus extending from person to 
person in close proximity, let us pause a moment and examine the value of this 
fact. At all the places where yellow fever prevails in the United States, it 
appears at distinct intervals of different lengths. It breaks out and rages for a 
season, disappears entirely, and, after a lapse of time, returns again. When 
it reappears, how often can it be traced, with reasonable probability, to infected 
vessels, goods, or persons? If this can be done in considerable majority of 
instances, it will be sufiicient to make a ride, and the instances in which such 
a connection cannot be fairly traced, must be set down as exceptions to the rule. 
Now I maintain, after careful observation of the outbreaks of yellow fever at 
New Orleans for the last twelve years, that no such connection could be rea- 
sonably traced in any instance. Nor has it been traced in a satisfactory 
manner in Mobile, Natchez, Vicksburg, or any other place in the United States 
where this disease has often prevailed. Hence, the great majority of the phy- 
sicians, and others who have had the best opportunity of observing, have come 



1854.] Fenner, Yelhio Fever at New 0rlea7is, La., in 1853. 189 



to the conclusion that epidemics of yellow fever do not imially, if ever, originate 
from this source. This is also the uniform conclusion, with hwt few exceptions, 
of all those who have seen most of the disease in all parts of the world where 
it prevails, as any one can see who will examine the volumes of testimony that 
have been published on the subject." 

Again, in speaking of the conveyance of the fever by those affected with it 
to places remote from that in which it was contracted, Dr. Fenner says: — 

" In such instances" — that is, the removal of the sick to unaffected dis- 
tricts — "which are very frequent, and doubtless familiar to thousands of per- 
sons in this region, how often is the disease communicated to those who come in 
contact with it ? I will venture to say, not as often as once inffty cases. JMany 
would say, not once in a hundred. Two highly intelligent gentlemen of Mem- 
phis, have recently told me that probably not less than seventy-five cases of the 
malignant yellow fever of this year were landed from the steamboats at that 
place, and there died, or recovered, without communicating the disease in a 
single instance. Dr. Jewell, of Philadelphia, informs us that eleven cases of 
yellow fever were admitted from the infected district into the Pennsylvania 
Hospital, and three into the Blockley Almshouse ; they were mixed promis- 
cuously with other patients, yet the disease was not communicated in a single 
instance. Dr. Ball, of this city, who on behalf of the Howard Association, visited 
the village of Providence Avhen the epidemic was at its height, tells me of seve- 
ral instances in which the disease was taken back to the plantations without 
being communicated. I will not weary the reader with instances of the kind. 

" If, then, it be true that yellow fever is not communicated from one person 
to another by immediate presence or contact, independent of other influences, 
oftener ih^n once in fifty or a hundred exposures, it would certainly make but a 
rare exception to di, gQnQvviX y\Aq', and this I believe to be about the true and 
real value of the now popular and warmly advocated doctrine of the conta- 
giousness of yellow fever . It is equally applicable to foviites of all kinds." 

All that we know of unquestionably contagious diseases, proves, that their 
capacity to propagate themselves by a specific poison, generated in the systems 
of those affected Mnth them, is their invariable characteristic. We know of no 
facts that countenance, in the slightest degree, the idea that a disease, admit- 
ted to be, ordinarily, of malarious origin, and which, we are assured, is ever 
known to spread in a healthy district into which those labouring under it 
are introduced, may occasionally assume a contagious character. The fact, 
which cannot well be contested in the face of the mass of incontrovertible 
testimony which has been accumulated in its support, that the yellow fever 
originates'in local morbific causes, altogether independent of any contagious 
principle derived from those already affected with the disease, and strictly 
limited to districts more or less circumscribed, is, to us, conclusive evidence 
that under no circumstances does it assume a contagious character. The few 
instances that have been reported in which the fever has appeared to be 
communicated by the sick to the well, or conveyed by the infected to distant 
and healthy localities, are all capable of an easy explanation, without the ne- 
cessity of resorting to the absurd notion of a contingent and occasional con- 
tagiousness. 

In regard to the characteristic features of yellow fever, so strongly insisted 
upon by many writers on the disease, Dr. Fenner remarks: — 

"The general impression derived from reading descriptions of yellow fever 
is, that it is a violent fever of a single paroxysm, lasting about seventy-two hours, 
and presenting strongly marked characteristic symptoms, by which it may readily 
he distinguished from all other types of fever. I have not found it so; nor have 
I yet found the man who could always say correctly whether a case, examined 
per se, was yellow fever or not. I have already shown that differences of 
opinion were expressed about the first cases that appeared this year, and have 
only to add that the same thing occurs here every year. The truth is, yellow 
fever is so closely allied to various remittent and intermittent fevers, that no 
uniform and reliable distinction can be drawn between them in the early 
stages; and the only way we get at the fact that yellow fever is prevailing, is 
bv observing the final results, whether in death or convalescence ; and the former 
No. LV.— July 1854. 13 



190 



Bibliographical Notices. 



[July 



is by ftii" the most conclusive of the two. Even in such an epidemic as this, 
thousands of cases occurred which no one would have thought of calling yellow 
fever, if it had not been generally known that raany of the same character and 
appearance had terminated in fatal black vomit." 

Dr. F. notices as a feature of the epidemic of 1853, a tendency to relapse, 
■which presented itself in many instances: — 

" After the customary subsidence of the fever at the end of the third day, 
there would be a period of calmness, lasting from twenty-four to forty-eight 
hours, and then the fever would kindle up again, and last for one day or more. 
This secondary fever was often very dangerous, though it frequently termi- 
nated happily. The interval of convalescence after the first attack was some- 
times so lung as to appear more like a second attack than a relapse. From two 
to four weeks have been known to elapse between two distinct attacks of the 
fever in the same person. Heretofore, those relapses, or second attacks, were 
not at all common." 

In regard to second attacks of yellow fever — that is, in persons who have had 
the disease in former years, we are told by Dr. Fenner, that — 

" There can be no doubt that if a person have a plain attack of yellow fever 
during the prevalence of a severe epidemic, there will be but small probability 
of his ever having it again, provided he remains in the same place ; yet the 
rule is by no means invariable. If one has it, however, during a mild epidemic, 
or Avhen there are only a few sporadic cases, his subsequent exemption 
not be near so great. Thus, there were numerous attacks this year among 
persons who had other attacks since 1847, but not many among those who had 
It that year, or any previous strong epidemic." 

Dr. F. notices a number of second attacks that occurred during the epidemic 
of 1853, either under his own observation or that of his medical friends ; in 
many of these cases, however, the fact of the first attack is based solely upon 
the patients' own statements, upon which, in all instances, the fullest reliance 
canni)t be placed. 

In reference to the supposed immunity enjoyed by the Creoles or natives of 
New Orleans from an attack of the fever, Dr. Fenner states, that — 

" One of the most extraordinary features of the epidemic of 1853, is presented 
Jn the fact that the natives of the city, both white and coloured, have suffered 
severely, and many of them died of it. This is generally admitted and beyond 
dispute. Children who were born since 1847 have suffered most; but many 
born previous to that time likewise suffered, and some of them died of black 
vomit. I saw two quadroon girls, sixteen and seventeen years of age, who 
were natives, and had never lived anywhere else — they had the fever severely, 
but recovered. A child, aged five years, in the same family, also had it. I 
attended a quadroon boy, about eight years of age, who had a severe attack, 
attended with hemorrhage from the gums. I have already mentioned the case 
of a white infant, only jive weeks old, that died of black vomit. It may be 
stated generally that all children and young persons in the city, who . had never 
had yellow fever previously, were attacked this year. Of course, there were 
some exceptions to this, as there are to every general rule. 

"I am informed that the Creoles on the coast, above and below the city, 
suffered much worse from yellow fever than those in the city, many adults 
having died of the disease." 

It appears that during the epidemic of 1853, iinacclimated negroes, or those 
who had never had yellow fever before, were equally as liable to attacks of the 
disease as the white population, but the disease was not so severe and fatal in 
.them as in the whites generally. 

" This is equally true," Dr. F. remarks, "of the mixed races generally. It 
is a well-established fact that there is something in the negro constitution 
which affords him protection against the worst effects of yelloAV fever; but 
what it is, I am unable to say. During an epidemic, he will take the fever 
almost, if not fully as readily as the white, but it will be altogether milder and 
less dangerous in its tendency. In short, it will correspond more exactly with 
the bilious remittent fever that prevails in the country, and requires precisely 
the same treatment. And yet this type of fever in the city negro must be pro- 



1854.] Fenner, Yellow Fever in New Orleans, La., in 1853. 191 



duced by the very same cause that gives rise to malignant yellow fever in the 
■white race. Occasionally, we see the hemorrhagic diathesis of yellow fever 
displayed in the negro — but it is by no means common. The least mixture of 
the wJiite race with the hlack seems to increase the liability of the latter to the 
dangers of yellow fever; and the danger is in proportion to the amount of 
white blood in the mixture. Very few negroes ever die of yellow fever in this 
city; but 1 learn that a considerable number have been lost on the plantations 
this year. The cause of this may readily be imagined, when it is recollected 
that yellow fever never prevailed on the plantations before, and of course most 
of the physicians were not familiar with its treatment. 

" I consider the danger to negroes from yellow fever to be no greater than 
that from bilious fever in the country, and not half so great as from congestive 
intermittent." 

Dr. Fenner estimates the chance of recovery, when well-marked black vomit has 
occurred in a case of yellow fever, to be but little better than one in a hundred. 
He nevertheless presents quite a respectable list of such recoveries, which dur- 
ing the epidemic of 1853, occurred under his own observation and that of other 
physicians of New Orleans. 

We close our notice of Dr. Fenner's history by the following extract, exhibit- 
ing his experience, during the late epidemic, of the " abortive treatment" of 
yellow fever by large doses of quinia, so highly extolled in some of his pre- 
vious writings: — 

"In 1847, and ever since, till the present season," he remarks, "I have 
been able promptli/ to cut short nearly all the cases of yellow fever I was called 
to treat in this city; and tliere was but one year (1851), in which there was 
not a good .deal of it to be treated. Several other highly intelligent phy- 
sicians of this city have done the same. Our chief remedies for this purpose 
were large doses of quinia and opium, given at the onset of the fever. In re- 
porting my satisfactory success with this treatment, I admitted that the disease 
treated, although certainly yellow fever, was of rather a milder type, and that 
it remained to see whether this abortive treatment would be equally successful 
in a more malignant epidemic. The opportunity has been presented this year, 
and I must make a candid statement of the results of my experience. 

" When this epidemic broke out, I was one of the visiting physicians to the 
Charity Hospital, and soon had ample opportunities to test the abortive treat- 
ment by large doses of quinia and opium. It did very well in many cases 
where there was a fair opportunity to apply it, but I soon discovered that it did 
not display that controlling influence over this fever which it had done over all 
the yellow fever I had met with for six years previously. I then fell upon a 
more moderate use of the sulphate of quinia, and finally gave preference to the 
ferro-cyanuret, in combination with blue mass, and without opium or morphia. 
I was pleased with the results, and pursued this course to the end of the 
epidemic. 

" I do not recollect to have treated any case of yellow without giving quinia 
in some form, and am willing to compare results with any physician in the 
city. I still believe it to be one of the most, if not the most valuable of all our 
remedies in yellow fever — in short, that it is just as valuable in this type of 
fever as it is in bilious remittent. Many physicians tell me that they found 
the sulphate of quinia to fulfil their expectations this year as well as usual, 
whilst others report quite difi'erently." D. F. C. 



192 



Bihliograpliical Notices. 



[July 



Art. XIX. — Woman: her Diseases and Remedies. A Series of Letters to Ms 
Class. By Charles D. Meigs, M. D.. Professor of Midwifery, and the Dis- 
eases of Women and Children, in the Jefferson Medical College at Philadel- 
phia, &c. &c. Third edition, revised and enlarged. Blanchard & Lea, 
Philadelphia, 1854. 8vo. pp. 672. 

Whatever fault may be found with, those peculiarities of style in which 
Dr. Meigs delights to indulge, and hovt^ever much a few startling generaliza- 
tions in pathology and therapeutics that are advanced by him may be repu- 
diated as unsound, still, the work before us ranks confessedly among the best 
modern treatises on the diseases of the female — presenting, in general, correct 
delineations of their symptoms, sound views in regard to their seats and cha- 
racter, and clear directions for their management founded upon extensive expe- 
rience and close observation. 

In the edition just issued, the work has evidently undergone a very thorough 
revision, while many important additions have been made to different portions 
of it, calculated to render it more complete, and thus materially to augment its 
value as a practical treatise on the diseases of woman. We sincerely trust that 
the life of the author may be spared to superintend many future editions, each 
of which, we feel assured, will be more acceptable in their teachings than the 
preceding, and, we should also hope, less exceptionable in style and language 
than the one before us. . D. F. C. 



Art. XX. — Handbook of Chemistry, Theoretical, Practical, and Technical. By 
F. Abel, Professor of Chemistry at the Royal Military Academy, Woolwich, 
&c., and C. L. Bloxam, formerly First Assistant of" the Royal College of 
Chemistry, with a Preface by Dr. IloflPmann, and numerous illustrations on 
wood. Philadelphia, Blanchard & Lea, 1854. 8vo. pp. 681. 

The progress of Chemical science, and the increased attention which it has 
attracted, have rendered necessary the publication of treatises devoted exclu- 
sively to peculiar departments. That of Analytic Chemistry has heretofore 
been treated in works which, to a considerable extent, presuppose an acquaint- 
ance of the student with general and theoretical Chemistry, and have hence 
noticed in detail only the methods by which substances should be examined, 
and the constituents detected and fully determined. Feeling, from experience, 
the want of a single work in which the " result only of a long chain of reason- 
ing" should be presented to the student as a means of enabling them to acquire, 
at the least expenditure of time, a sound basis for the education of the profes- 
sional chemist, they have been induced to bring this handbook before the v 
public. The testimony of Dr. Hoffmann to the abilities of the authors is a 
suf&cient recommendation, and will be found fully borne out by an examina- 
tion of the work itself. 

The first chapters give a short account of specific gravity, equivalents, 
affinity, nomenclature, notation, and the physical condition of bodies. Then 
follows a full account of chemical manipulation, in which minute descriptions 
are given of the kinds of apparatus best adapted to the various processes, the 
•different instruments necessary in the construction and fitting of the various 
forms, and the precautions necessary in construction and manipulation, com- 
prising all that the student will be called upon himself to prepare or use, 
together with occasional illustration of important points by instruments of less 
common character, and containing in fifty-four pages matter, which, in all its 
details, should fix the full attention and appreciation of the'^student as an 
essential preliminary to the acquisition of careful habits, and dexterity in prac- 
tical operations. 

The elements, and many of their compounds, are then noticed so as to con- 



1854.] 



Fownes, Elementary Cliemistry. 



193 



vey all the knowledge necessary of general and theoretical chemistry without 
entering upon unnecessary detail. As it is necessary that the analytic chemist 
should have some knowledge of the methods of preparing objects which he may 
be called upon to examine, the processes used in arts and manufactures have 
been given, but without entering into mechanical details unless having some 
particular bearing on the results as found in commerce. 

The concluding portion of the work is devoted to qualitative and quantitative 
analysis, in which the practice of the Giessen school is followed — modified, 
however, as experience in teaching has suggested, and in which is given evi- 
dence of judgment and ability in this branch of the science. 

The American edition is issued in form and appearance well worthy of imi- 
tation in works of a similar class, and the facilities of the students have been 
enhanced by the introduction of appropriate wood-cuts of apparatus which, in 
the English, are only described, and would be constructed with difiiculty, by 
one not familiar with the best forms of apparatus, without such aid as is here 
given. 



Art. XXI. — Elementary Chemistry, Theoretical and Practical. By George 
FowNES, F. R. S. Edited, with additions, by Robert Bridges, M. D., Pro- 
fessor of Chemistry in the Philadelphia College of Pharmacy. A new 
American from the last revised London edition. Philadelphia, Blanchard & 
Lea, 1853. 12mo. pp. 555. 

This well-known work has, since the author's death, received the careful 
revision of Messrs. H. Bence Jones and A. W. Hoffmann, whose names are 
well known as connected with chemical inquiry. The original work has 
created for itself so firm a reputation, that it will be incumbent on us to notice 
only the recent additions rendered necessary by the constant progress of the 
science. These have been made principally in Organic Chemistry, but we may 
observe that the Inorganic department has not been overlooked — the nomen- 
clature modified, equivalents corrected, processes added, &c., whenever neces- 
sary. In Organic Chemistry, the additions are of a very interesting character, 
the most prominent of which stand the alcoholic series, in which the results of 
the electrolysis of valerianic acid by Kolbe, and also of acetic acid, with the 
valuable views deducible therefrom, are clearly related, and the results which 
the study of the relations in composition of this class have elicited, and which 
will probably lead to important effects, are carefully developed in pages 393 to 
396. New alcohols are added to those previously known, and many new and 
important compounds of the series, as the cyanates and cyanurates, carbonates, 
&c. are added. In the benzoyl series, we find benzoyl the radical of benzoic 
acid, and the valuable observations of Noad, Cahours, and Gerhardt, on the 
homologous compounds. 

The Organic Acids are enriched by the observations of Pasteur on racemic, 
and Piria on malic acids. Organic bases have been enlarged to a considerable 
extent, not only by additional accounts of new natural bases and their salts, 
but also by an extensive notice of those of artificial origin derived from the 
different members of the alcoholic series, from coal tar, animal oil, aldehyde, 
and those containing phosphorus and antimony. 

To the cyanogen compounds the nitro prussides of Playfair are appended, 
and the articles on litmus, cochineal, madder, &c. have been rewritten. 

The above succinct statements of the more prominent additions will be su£&- 
cient to exhibit the attention which has been bestowed by the editors in their 
revision, and it will be found that the very few paragraphs which have been 
dropped from the original are such as more accurate knowledge has rendered 
neces'sary, and which " the author himself would have desired, if his life had 
been spared to science." 

The American edition has also added to it valuable notes, and in paper and 
execution will bear comparison with those previously issued. 



194 



Bihliograplu'cal Notices. 



[July 



Art. XXII. — Eemarls on tlie Ori^nn of the YeUoic Fever wJiich prevailed in 
PhiladeJpliia, in 1S53. R. La Roche. M. D. (Transactions of the College of 
Physicians of Phikdelphia, Vol. II. X. S., Xo. IV.) 

Though the controTersj, relative to the origin of the yellow fever epidemics, 
which have at different times prevailed in our principal Atlantic cities — whe- 
ther it be of domestic origin or imported from abroad — has lost the bitterness 
of feeling w]iich formerly characterized it; each opinion has still its advocates. 
The zeal of the partisan has now, however, given way to the anxious and 
honest search after the truth, and we cannot doubt, therefore, but that the 
question will be soon settled. 

In our present number will be found an interesting account, by Dr. Porter, of 
the yellow fever which prevailed at Sullivan's Island, Charleston Harbor, S. C, 
in 1852, in which the author shows conclusively, we think, that the epidemic 
arose from local causes. Dr. Fenner has proved (see our present Xo., p. 184, 
et seq.) that the yellow fever epidemic at Xew Orleans last year had a similar 
origin, and Dr. La Roche, in the interesting paper we are now to notice, main- 
tains that the yellow fever which prevailed in Philadelphia last summer was 
due to a like cause. 

Dr. Jewell, whose account of this last epidemic we gave an abstract of in 
our previous number (p. 543, et seq. ), seems to incline to the belief that the dis- 
ease was brought here by the barque Mandarin. 

The grounds upon which the belief in question has been founded are the 
following : — 

"1. A vessel, the barque Mandarin, left Cienfuegos, Cuba, for this port, on 
the 25th of June, all in good health, with a cargo of sugar, molasses, and 
cigars. 

" 2. At the time of her leaving Cienfuegos no epidemic prevailed there; but, 
according to the report of the captain, 'a few cases of smallpox and fever ex- 
isted.^ The crew lived on board while in port, anchored off the town, were 
seldom on shore, and, as far as the captain knew, none of them had visited the 
sick. 

" 3. The vessel arrived at the Lazaretto, July 12, after a passage of seventeen 
days ; her crew originally consisting of twelve men. Of these, two died of 
fever during the passage. The first was attacked when eight days out from 
Cienfuegos, July 3, with fever, and died on the 7th. The second sickened on 
the 4th uf July, and died on the 9th. 

"4. At the time of arriving at the Lazaretto, the crew, numbering ten souls, 
were, on examination, found to be in good health. X'evertheless, it was con- 
sidered prudent that the barque should be detained until thoroughly ventilated, 
cleansed, and fumigated. The bedding and clothing of the deceased sailors 
were destroyed, the vessel was whitewashed and fumigated in every part with 
chloride of lime, while the bedding of the crew were aired and their clothing 
washed. She was detained an entire day. 

"5. The Mandarin reached the city on the 13th of July, and came to at 
South Street wharf. On the 16th, she was hauled up to the lower side of the 
first pier below Lombard Street, where she discharged her cargo. On the 20th, 
seven days after her anivah she dropped down to the lower side of the first 
pier above Almond Street, where she remained until the 26th. From this she 
was removed, by the Board of Health, to the cove below the Xavy Yard, whence, 
on the 28th, she was remanded to the Lazaretto, in order to undergo a more 
rigid and thorough purification. The crew having been previously discharged, 
the captain and mate remained by her, sleeping on board. 

" 6. There was no disease of a malignant type in the vicinity of where the 
vessel lay, ' as far as has been ascertained,^ either before or during the time 
of discharging her cargo. Xo epidemic was prevalent in any part of the city. 
There appears to have l3een no cause for alarm until the cargo was out of the 
vessel, when it was noticed that a very offensive smell proceeded from her hold. 
Subsequently, but not before the vessel had been removed to Almond Street 



1854.] 



YtlloiD Fever in PhiladeJpliia in 1853. 



195 



•wharf, the stench became intolerable, especially whenever the puii^s agitated 
the bilge-water contained under the limber planks or flooring of the hold. 

" 7. The first case of a suspicious character which occurred in the neighbor- 
hood was on the 19th of July, six days after the Mandarin reached South 
Street wharf, three days after she was removed to the pier below Lombard 
Street, and the day before she left this last position for Almond Street wharf. 
The individual attacked drove a furniture car, and stood on the upper side of 
South Street. On the nest day, the 20th, five new cases occurred, all in per- 
sons residing near, or frequenting many times a day, South Street wharf, or 
the vicinity. The next, or seventh case, was the mate of the Mandarin. He 
was attacked on the 21st. Other cases occurred that day and the following, all 
of which were traced to South and Almond Street wharves, and other neigh- 
boring localities. On the 23d — consequently, while the Mandarin lay at Almond 
Street — the captain was seized with the disease. He was removed to Clements's 
Hotel, Delaware Avenue, between South and Lombard Streets, where he re- 
covered. 

" 8. From this time the fever gradually spread ; but all the cases that occur- 
red up to the 27th of July either resided or did business in the vicinity of 
South Street wharf. ' Xor is it known,' says Dr. Jewell, 'that any case ori- 
ginated below or south of where the vessel had been last moored, nor has any 
case come within our knowledge north of Lombard Street.' Subsequently, 
however, the disease extended and assumed the character of an epidemic, oc- 
cupying, with few exceptional cases, a locality extending from Union Street 
north, to Queen Street south (about 600 yards); Second Street west, and the 
Delaware on the east (200 y^rds). It did not cease before the middle of Oc- 
tober." 

" It appears, therefore," says Dr. La Roche, "from the foregoing statement, 
that a vessel arrived from a port of Cuba, where, at the time of her departure, 
there did not prevail any epidemic of malignant disease, but only a few cases 
of smallpox and fever: that a few days after her departure, two of her crew 
died of fever; that the bilge-water was in an impure state, and emitted an of- 
fensive smell; that when she reached the Avharf, the vicinity of the place, as 
well as the city generally, enjoyed the usual ratio of health of the season ; that 
a few days after her arrival, the yellow fever broke out in the vicinity of the 
place where she lay ; that the disease, during some days, remained circum- 
scribed within a very short distance of the spot where it first broke out, and 
that, with a few exceptions, it continued to preva,il in the neighbourhood of South 
Street wharf, occupying an area of two or three squares in a northern and 
southern direction, and of a third of that distance westwardly." 

An attentive examination of all the facts, satisfies Dr. La Roche, that the 
barque Mandarin had no agency in the production of the fever; " that the lat- 
ter was due to the operation of local causes situated in the vicinity of the place 
where it broke out a"nd prevailed ; that these causes were similar to those which 
have given rise to the same disease at other times, here and in other situations, 
and that the fever would have prevailed just as surely had no such vessel ar- 
rived from the West Indies." 

" In the first place, there is no proof — nay, there is no reason to believe" — 
Dr. La Roche remarks, " that the sailors who sickened and died on the passage, 
admitting that they had the yellow fever, a circumstance which has not been 
proved, took the disease from causes existing in the vessel. It is just as likely 
their sickness was due to a febrific poison inhaled by them while at Cienfuegos. 
We are told that, though no epidemic was prevailing at that place at the time 
of their departure, sporadic cases had occurred. They generally do so at that 
season of the year in all tlie West Indian ports among unacclimatized strangers 
and especially sailors. The cause of fever, therefore, was in operation in the 
town; and we know that the crew of the Mandarin were, if not often, at least 
sometimes, on shore, where doubtless they indulged in sprees, as sailors are very 
apt to do. What prevents those who suftered at sea from having imbibed the 
seeds of the fever when they landed ? Or, supposing them not to have landed, 
what prevents the febrile poison from having been wafted to the ship which 
was anchored off the town, and of course at no great distance from the latter, 



196 



Bibliographical Notices. 



[July 



and certain^ not beyond the reach of malarial effluvia? Sucti things have 
often occurred in tropical ports v^here there are no "wharves or quays ; wliere 
vessels are all anchored off the town, and where, unless the distance is great, 
or some intervening cause exists, the men are liable to receive the infection 
although carefully refraining from going ashore. Add to this, that the men, as. 
I have lately learned, slept not in the forecastle or other parts below, on ac- 
count of the oppressive heat that there prevailed, but in the longboat; and that 
those that died v^ere only taken below after they had sickened. Now, of all 
places on shipboard, the longboat is about the last where the yellow poison 
could be expected to be formed or to lurk. As well might we suppose it to be 
formed in the rigging. 

" The period at which those men sickened cannot be urged in disproval of the 
opinion here suggested; for it is not uncommon, especially when the epidemic 
influence is not very violent, to find the disease breaking out on the 8th and 
9th day after exposure, as was the case in the instances in question, and even 
later. The very circumstance of the two men taking sick in such rapid suc- 
cession, would lead me to infer they had imbibed the seeds of the disease be- 
fore leaving Cienfuegos ; for it is not probable, had the poison been formed and 
exhaled in the vessel, that the two cases would have occurred almost simulta- 
neously, and that the disease would then have ceased to appear until some days 
after her arrival. The occurrence, of course, is possible. It appears to me, 
however, more probable, had the fever originated from local sources of infection 
existing on board, that the cases which occurred would have done so at a longer 
interval from each other, or, what might be still more natural to expect, that 
the disease would have continued to show itself off and on during the rest of 
the passage. So far, however, from this occurring, no one else on board ap- 
pears to have suffered from sickness ; for when the vessel arrived at the Laza- 
retto, and the men, ten in number, were examined by the physician, they were 
all found to be in good health ; and the captain, before being permitted to pro- 
ceed to the city, declared on oath, that no sickness, except that resulting in the 
death of the two seamen, had occurred during the voyage. 

" This was on the 13th of July. On the 16th, the vessel having been hauled 
up to the lower side of the first pier below Lombard Street, the crew was dis- 
charged, the captain and mate alone remaining. None of the men so dis- 
charged were since ascertained to have died or sickened. Now, had the Man- 
darin really been in an infected state, the result here adverted to could not 
very well have obtained. On examining the records of vessels in which the 
yellow fever has truly originated and prevailed, matters are usually found to 
assume a different course. In all, the proof of this origin is established on 
something more substantial than the sudden appearance of two cases, preceded 
and followed by the perfect healthiness of everybody else on board. Nor is 
this all. Had the Mandarin been the focus of infection — had she contained 
the seeds of the disease in her hold, w^e might have expected to find those who 
were subsequently employed on board to suffer, in greater or less number, from 
the disease instead of escaping to a man, while others at a distance were at- 
tacked. Such certainly has not been the result in instances in w^hich the poison 
was undeniably formed on shipboard. Now, w^hat has been the case in respect 
to the Mandarin ? We are told that none of the laborers employed in unload- 
ing her, and who must have been sufficiently exposed, in all conscience, to the 
action of the poison had it been elaborated and accumulated in the hold, took 
the disease. Furthermore, on the 26th, when the cargo had been discharged, 
when the hold had been opened, when the disease supposed to have been intro- 
duced by her, had already broken out, when, as it is stated, the noxious ema- 
nations which had been latent in the hold and under the limbers of the vessel 
had an opportunity to escape from their place of confinement, when, of course, 
the vessel must have been saturated wnth them, and when cases of fever are 
supposed to have originated from merely sitting some hours in her vicinity 
while she lay at Almond Street wharf; — on the 26th, I say, the Mandarin, by 
order of the Board of Health, was taken in charge by the Health Officer, who 
put on board a crew of five men, including the watchman. These men re- 
mained in her from that date up to the 29th of July, when she was safely 



1851.] 



Yelloic Fc^er in PhUadelplita in 1853. 



m 



anchored inside the ishxnd Littlp Tinicum, opposite the Lazaretto, -and placed 
in charge of the quarantine-master. What was the result? Did any of these 
men suffer from the deleterious effects of the poisoned atmosphere of this ves- 
sel? No, far from it. ' Neither the Health Officer nor any of his men, nor did 
the watchman who remained on board until after her purification and return 
to the city, experience an hour's sickness.' At the Lazaretto, the Mandarin 
remained from the 29th of July to the 2d of August; several of her limber 
planks were removed. ' She wg-s then scuttled and filled with water, which 
remained in her twenty-four hours. The holes were then plugged up and the 
water pumped out. Next, she was thordughly whitewashed, and, in every part 
of her, chloride of lime was freely distributed.' 

" All these operations — which, let it be said in passing, are not, under con- 
ditions of atmosphere such as those that existed at the time, very generally 
successful in eradicating the disease from a really infected ship — require con- 
siderable exposure on the part of the individuals employed in carrying them 
out ; and yet we are told that, during this process of expurgation, ' the Quaran- 
tine Master, with several of the bargemen at the station, were on board and 
at work in the hold, cabin, and other parts of the vessel for several hours dur- 
ing each day — the weather excessively hot — without any inconvenience to their 
health.' On her return to the city, the 3d of August, slie was moored at Noble 
Street wharf, Northern Liberties, where she remained until the close of the 
month ; then was removed to the screw-dock, Kensington, for repairs, and on 
the 6th of September was taking in cargo between Arch and Race Streets, pre- 
paratory to a voyage to New Orleans. In these different localities, no cases 
could be traced to exposure -to the atmosphere in or near the vessel. Indeed, 
as we are informed by Dr. Jewell, no sickness whatever followed in her track 
after she left Almond Street wharf on the 2(3th of July. 

"A result of this kind could scarcely be looked for had the vessel been the 
focus of infection. It is one which could not be anticipated by those who have 
examined the history of vessels in which the fever poison originated. In such 
instances, the danger of infection is far greater to those who are on board, 
especially if employed below, than to those who remain outside ; while in very 
many cases the danger is limited exclusively to the former; and, it is well 
known, that the operation of expurgation, when performed in yellow fever 
regions, and especially during hot weather, is one of great danger to all but 
Kroomen and negroes, to whom, on the Coast of Africa and in the "West Indies, 
it is exclusively assigned. In the instance of the 3Iandarin, however, the dan- 
ger was, as it would seem, the share of those who abstained from going aboard 
and remained at a greater or less distance, many of whom not only did not 
approach her, but did not, nor could, in any possibility, see her. 

" Let it not be said that both the captain and the mate of the Mandarin, who 
remained and slept on board after the crew had been discharged, took the fever, 
of which the latter died; and that from this circumstance %ve are justified in 
concluding that the poison was generated in the hold of the vessel. These 
men were attacked some days after the disease had broken out in the vicinity; 
the mate on the 21st of July, and the captain on the 23d. They were not the 
first cases, as would probably have happened had the poison issued from the 
hold. They were, while attending to their duties and sleeping on board, ex- 
posed to the exhalations from the same local sources of infection which were 
exercising their baneful influence over the people of the neighborhood. In- 
deed, they were more exposed than the generality of others who were attacked 
during the season, for, like some of the other early cases, they slept on board, 
and consequently in the focus of the local infection; and it is well known that 
malarial exhalations are more active and dangerous at night, and are especially 
liable to affect individuals exposed to them during the state of sleep. 

" Nor can we attach much importance to the circumstance that two of the 
early cases were those of the captain of a vessel lying in Lombard Street dock, 
next above the pier where the Mandarin dischar>j;ed her cargo, and of the mate 
cf another vessel close by, and that subsequently other cases occurred among 
the men employed in the first-mentioned vessel. There is no proof that these 
took the disease from the poison issuing from the Mandarin, any more thaa 



198 



Bihliographical Notices. 



[July 



from a morbific agent originating, as it has on former occasions, along the 
wharves. While they were falling sick above the place where that barque 
lay, others were sickening below, and without approaching the latter. In vi- 
sitations of the yellow fever in this city and elsewhere, the local sources of 
infection, though at first circumscribed within rather narrow bounds, have- 
seldom been found to remain so beyond a limited period. They soon cover 
a surface of a few hundred feet, and do not attain their full limits until some 
time has elapsed. We may very well understand, then, that cases can have 
occurred almost simultaneously at South and Lombard Street wharves, without 
being obliged to attribute some or all of them to the Mandarin. Even if we 
suppose the cause to have been limited to South Street wharf, where, as we 
have seen, the first cases and several of the succeeding ones presented them- 
selves, we can be at no great loss^to account for the cases on board the Man- 
darin and neighboring vessels ; for we are told that the captain of the former, 
though sleeping on board of his vessel, took his meals at the Champion House, 
near the northwest corner of South Street and Delaware Avenue; and it is not 
improbable that he, as well as the other men who sickened close by, visited 
that same locality, and that they all perambulated the wharves at night. Cap- 
tains, mates, and sailors of merchant vessels are not proverbial for their 
sedentary habits, and when their day's work is over are little apt to seclude 
themselves within the precinct of their vessel. 

" To this I may add that little support is afforded to the opinion respecting 
the agency of the Mandarin in introducing the disease, by the facts that an 
individual from the country, who had visited the Avenue on Thursday and 
Friday evenings (21st and 22d of July), and sat for an hour or more on the 
wharf at Almond Street, where that vessel lay, took the disease on the 23d, 
and that the captain of the brig Reform, lying on the north side of the pier 
above Almond Street wharf, where the Mandarin lay last, shared the same 
fate on the 2Gth ; for, independently of the little probability of these persons 
being morbidly alFected by a poison issuing from a vessel which, from the day 
she left Almond Street wharf (on the 25th), was fully exonerated from the 
charge of having done any injury to a single one of the many individuals who 
worked, ate, and slept on board, we find that other individuals, about the same 
time, took the disease in places remote from the vessel, and without having 
been known to approach her. Thus, for example, Honora Stanton, who resided 
at No. 16 Little Water Street, above South, some four or five hundred feet from 
Almond Street wharf, was taken sick on Friday the 22d, and died on tlie 27th. 
If cases could occur at a distance from the vessel, and if, amid the large num- 
ber of individuals who approached her during the time she lay at Almond 
Street wharf, only two took the disease, and if, besides, after she left that wharf 
no one sickened on board, we run very little risk in expressing a doubt as to 
her agency in the production of the two cases in question. The same causes 
that gave rise to those at a distance can well be considered sufficient to have 
occasioned those that occurred near Almond Street wharf, without referring 
the efi'ect to a vessel, the infection of which is, to say the least, very pro- 
blematical. 

"In addition, let it be here remarked that, when the limber planks of the 
Mandarin were removed, no mud or other collection of filth was found con- 
cealed there. The hold of the vessel had, it is true, often been, as the captain 
admitted, in a foul condition. It is true, also, that when the cargo was out of 
the vessel, it was noticed that a very offensive smell proceeded from the hold ; 
that after she dropped down to Almond Street wharf, the stench became in- 
tolerable, especially when the pumps agitated the bilge-water contained under 
the limber planks. And we are told, moreover, that in consequence of some 
defect in the pumps and of her being a tight vessel, the bilge-water could not 
easily be discharged, and as a consequence soon acquired a disagreeable smell. 
But all this does not necessarily make a sickly vessel, except under pepuliar cir- 
cumstances, and when carried to a greater excess than appears to have been the 
case in the instance of the Mandarin. All vessels that carry cargoes of sugar and- 
molasses are more or less foul, for the time being at least, and there are few 
of them whose bilge-water does not emit an offensive smell, sometimes an in- 



1854.] 



Yellow Fever in Philadelphia in 1853. 



199 



tolerable stench ; and yet comparatively few become laboratories of febrific 
poison. Indeed, although under particular conditions of atmosphere, and in 
particular latitudes, foul ships are very apt to be unhealthy, they are far from 
being necessarily so. Nor is it less true that a condition of bilge-water, such 
as is stated in reference to the Mandarin, however often connected with the 
manifestation of disease, is not always so ; cases having been adduced in which 
the foulest and most offensive water has proved innocuous ; while disease has 
raged where the odor Avas hardly, if at all, perceptible. 

" I may further call attention to the circumstance that the period at which 
the first reported cases occurred, must on reflection prove an obstacle to the 
idea of tracing the disease to the Mandarin. It must be remembered that 
this vessel reached South Street wharf on the evening of the 13th July ; that 
she was removed to Lombard Street wharf on the 16th ; that she there dis- 
charged her cargo and was removed to Almond Street on the 20th. It is not 
presumable, that before the vessel had reached Lombard Street, and the cargo 
had been discharged, the poison was lurking about her decks, cabin, forecastle, 
or longboat. Such things seldom occur even in ships more fully saturated than 
the Mandarin could possibly have been. Besides, the captain and mate, who, 
as experience showed, were not proof against infection, as well as the eight 
seamen who manned the barque, had been living on that deck, and in that 
cabin, forecastle, &c. with perfect impunity. The first cases, therefore, if they 
took the disease from the exhalations issuing from the vessel, did not and could 
not have done so while she was lying at South Street wharf. The efi"ect must 
have been produced when the hatches were opened, the cargo discharged, and 
the hold exposed. Dr. Jew-ell himself acknowleges the fact ; for he remarks 
that ' there appears to have been no cause for alarm until the cargo was out 
of the vessel, when it was noticed that a very ofi'ensive smell proceeded from 
her hold.' Now, if we bear in mind that the operation of unloading did not 
commence before the 16th — the day the vessel was hauled up to Lombard Street 
wharf — and could not have been effected in less than twenty-four or thirty-six 
hours, we shall perceive that the morbid effluvium, supposed to have been 
generated under the limber planks of the hold from the putrescent state of the 
bilge-water, and which heretofore had there remained in a latent state, could 
not have had ' an opportunity (acted upon by certain exciting causes, as heat 
and moisture) to disseminate itself,' and poison the atmosphere in the imme- 
diate neighbourhood of the place where the barque lay, before the evening of 
the 17th. If, with this fact before us, we turn to the date of the early cases, we 
shall find that the first occurred on the 19th, some thirty-six or forty hours only 
after the poison began to escape. On the next day, 20th, we have five cases. 
On the 21st, five more occurred. Here, then, we have an incubation of thirty- 
six or forty hours at most in one case ; an incubation of sixty to sixty-five in 
five cases, and an incubation of from eighty-four to ninety in five more. The 
occurrence will appear improbable to those who have paid some attention to 
the subject, especially if they take into consideration the circumstance that the 
poison, which is supposed to have so quickly stricken down individuals situated 
at a greater or less distance from the vessel, was powerless as regards those 
employed in discharging the cargo, and who consequently were most exposed 
to its morbific effects. Such instances of short incubation are rarely encoun- 
tered. Cases of course occur shortly after exposure — sometimes a few hours, 
or a day or two. They are mentioned in many works on the fever, and I have 
myself, in a recent publication, referred to several of a striking character. They 
are, however, generally observed only in places where the atmosphere is fully 
saturated with the poison, and in times of violent and wide-spreading epidemics. 
But, even under such circumstances, they are comparatively unfrequent and 
exceptional. More generally the process of incubation is of longer duration, 
requiring, according to some writers, from three to eight days, and in the 
opinion of the greater number, from five to ten. It has extended to three or 
more weeks, or to several months. Now it would be a rather extraordinary 
circumstance that, in the epidemic of last season, we should have had, at the 
outset, and in such rapid succession, so large a number of instances of unusu- 
ally short incubations, and that the disease should have attacked the first suf- 



200 



Bibliograj)hlcal Notices. 



[July 



ferer about a day and a half only after the poison could possibly have reached 
him, and the very next five only at the most twenty-four hours later. More 
consonant ^Yith our former knowledge on the subject, backed by what has been 
adduced against the supposition of the Mandarin having been the efficient agent 
in introducing the disease among us, is it to conclude that the individuals thus- 
attacked had imbibed a poison generated elsewhere than in the ship, and which 
floated in the atmosphere of localities where the disease broke out and prevailed 
before the cargo was discharged. 

" That causes capable of producing the effect, and similar to those which 
have again and again occasioned the yellow fever without the agency of a 
really or supposed infected vessel, existed in those localities, will not be denied 
by any one who inquired into the subject at the time. * The docks along the 
Delaware line, between Lombard and Almond Streets,' says Dr. Jewell (writ- 
ing in September), 'as usual contain large accumulations of offensive mud 
and other filth.' 'In addition,' continues the same writer, 'to the preva- 
lence of the morbific atmosphere which we have clearly shown developed itself 
on board the Mandarin, but not until her cargo was discharged, and which so 
sensibly affected individuals on approaching her when she lay at Almond Street 
•wharf, we must not for a moment conceal the existing causes in the immediate 
vicinity of South Street wharf, sufficient to justify the supposition of their 
agency in the development of disease of a malignant type, when subjected to the 
high thermometrical influence which prevailed throughout the months of June 
and July. Not the least mischievous of these causes, in the production of an 
unhealthy atmosphere, was the outlet of the sewer into the dock at South Street 
Ferry, belching forth continually putrid masses of animal and vegetable filth 
accumulating around its mouth, and exposed at low water to the rays of the 
sun, exhaling streams of unwholesome and poisonous gases into the surround- 
ing air. Besides this agent, there was a most foul wharf at the upper side of 
South Street; a filthy avenue between Lombard and South Streets, without 
any properly constructed surface drainage ; numerous damp confined cellars, 
subject to an occasional overflow by the ebbing and flowing of the tide-water of 
the Delaware, and various minor causes that might properly be added to the 
above category, fruitful in the production of atmospherical changes injurious 
to health.' 

"At a still later period (October 5), Dr. Jewell reverts to the subject, and 
after taking some pains to show that the disease was not sustained by an over- 
crowded population, he remarks: 'The whole neighbourhood, however, may 
be considered as favorable to the production and nourishment of malarious 
fevers, in view of its proximity to the river docks, the open sewer at South 
Street wharf, the damp cellars, filthy alleys, and other local causes of disease, 
under such a long-continued high thermometrical atmosphere, as prevailed 
during the months of July, August, and September. That of July being 77.14 
degrees, about two degrees above the average mean for many years ; August, 
76.76, or nearly four degrees above the common average for that month, accord- 
ing to Dr. Swift's review of the weather, published in the Medical News.' 

" Such accumulations of organic refuse, I repeat, have often, when located in 
places of the kind particularly, and when aided by certain thermometrical and 
hygrometrical conditions of the atmosphere, proved the source of the evolution of 
the yellow fever poison. To no other cause could our epidemics of 1805 and 
1819 be ascribed ; for there was not at those two seasons, the most remote pos- 
sibility of the disease being imported in any shape or form whatsoever. In the 
former, no vessel, likely to have rendered us this poor service, and exonerated 
our city from the dishonour of being ' the parent of such a pestilence,' had 
approached nearer than the Lazaretto ; and it is well known that, when, in 
1819, the disease broke out in the ferry tavern, on the upper side of Market 
Street, and in the contiguous buildings, there was not, nor had been from the 
commencement of quarantine, any vessel near them from the West Indies or 
any sickly port. Let it be remarked that, on those occasions, as indeed at every 
other return of the disease among us, the fact of its non-contagiousness was as 
satisfactorily made out as it was during the past season. Were it necessary, hun- 
dreds of instances, w^iich have occurred in other portions of temperate regions, 



1S54.] 



Yellow Fever in Philade^pliia in 1853. 



201 



might be adduced to show the local origin of the yellow fever from causes of 
the kind mentioned, and its independence of any exotic or imported poison. 
And. the most strenuous and ultra advocate of importation in this city and 
everywhere else, must acknowledge that, in the West Indies and on the coast 
of Africa, the disease is due to exhalations issuing from localities very similar 
to those to which we have for years past been disposed to attribute its origin 
here. During this very last summer, eight cases of what I would consider well- 
marked yellow fever, occurred in Brandywine Village, which were indubitably 
the result of local causes. Instances in large numbers are on record of the dis- 
ease breaking out and prevailing more or less extensively on shipboard under 
circumstances which leave no doubt as to its local origin there. Nor are such 
cases limited to vessels from the West Indies or the coast of Africa. They have 
shown themselves in some from cold climates, where they could not possibly have 
imbibed the seeds of the disease. They have occurred in port or at sea, during 
a cruise or passage, and far from any contaminating spot. It has not unfre- 
quently happened, that while a vessel is severely visited by the fever, others 
situated near it in port, or at sea, or on the same cruising ground, have re- 
mained uninjured. The very poison said to have existed on board the Manda- 
rin, is admitted to have been elaborated in her hold out of materials of the kind 
mentioned. And surely, if such has been the casein all the instances referred 
to, we cannot see why they may not be regarded as capable by themselves of 
having produced the effect in question last year on our wharves, especially 
when we bear in mind the atmospheric peculiarities of the season, and the great 
tendency manifested in most places south of this city and in tropical regions 
generally to the development of the disease. They certainly existed in greater 
excess there than under the limber planks and in the hold of that vessel ; and, 
if the foulness of the latter can be supposed to have been the source of the fe- 
brile poison, it remains to show why the foulness on shore could not have given 
rise to a like effect.'' 

Though the greater number of the cases, as Dr. La Roche remarks, "which 
prevailed during the season, from the I9th of July to the middle of October, 
were in the vicinity of the wharf where it originally broke out, and where it ia 
supposed the Mandarin introduced and left the poison which contaminated the 
atmosphere, the disease showed itself at a considerable distance from the place, 
and without the possibility of its being traced there directly or indirectly. Dr. 
Jewell, in that part of his essay which was read before the College on the 7th 
of September, gives us an account of forty-four cases that had up to that period 
appeared. Of these, thirty-seven were traced directly to the infected district. 
In four, the origin was doubtful : and in three, no clew could be had as to where 
the disease was contracted. In other words, they could not be shown then, and 
cannot be proved now, to have taken the disease in the infected district, pro- 
perly so called, i.e. within a short distance of where the Mandarin had lain;- 
while they sickened too far from that district to permit us to think that the air 
contaminated by the vessel could have reached them, especially as we find that 
it did no injury to the intervening population. In his last communication (Oct. 
5), Dr. Jewell states thai the whole number of cases registered had amounted 
to 170. Of these, 147 were traced directly to the infected district ; 22 were of 
doubtful or unknown origin, and one contracted the fever elsewhere. Of these 
22, three occurred in September, in the upper part of the city, fully a mile and 
a half north of South Street, but not far from the Delaware front. The history 
of the first of these three cases could not be ascertained ; but there is no reason 
to suppose the patient had approached the infected district. He resided in 
north Front, near Callowhill. The subject of the second case, was the wife of 
the first, ' This woman declared that, so far from visiting the vicinity of South 
Street, she had not even crossed the threshold of her own door for several 
weeks, having a family of small children around her. The room she occupied, 
the third story front of an unfinished warehouse, was very filthy, but large, and 
by no means confined. The whole upper part of the building was rented out, 
in rooms, to different families of the low order of Irish, everything around pre- 
senting poverty, rags, and filth.' The subject of the third case resided about 
one square north of the preceding, in Willow Street, two doors west of Front. 



202 



Bihliograph ica I Notices. 



[July 



The individual, as we are told, ' unhesitatingly declared that he was not ac- 
quainted with the lower part of the city, did not know that he had ever been in 
the vicinity of South Street wharf; was a shoemaker, worked in Front Street 
above Noble, and was not in the habit of going anywhere else, but from his 
shop to his residence in Willow Street.' 

" Here we have cases of unmistakable yellow'^fever arising f;xr from the 
infected district, and in a locality where the atmosphere supposed to have been 
contaminated by a poison derived from the Mandarin could not have penetrated. 
Dr. Jewell, it is true, speaks of ' an epidemic influence stealthily creeping along 
the wharfs from the infected district, and which lent assistance to other causes 
in exercising a morbific agency on the individuals in question.' But he will 
have some difficulty in making us understand how an epidemic influence (the 
nature of which, by the way, he does not explain) could have travelled the dis- 
tance of a mile and a half, and, in its transit, passing over hundreds of vessels, 
and thousands of people, without influencing any but three individuals residing 
at the end of its journey. More natural will it be — more consonant with the 
result of experience here and elsewhere — to conclude that the disease arose, in 
the instances above mentioned, from the action of a local febrile poison ; and, 
setting aside the aforesaid mischievous intruder from South Street, join with Dr. 
Jewell in the opinion that the effect was due to a residence, on the part of the 
individuals seized, ' in the immediate vicinity of Willow Street wharf, where 
the culvert along Pegg's Run empties into the Delaware, which outlet, at low 
tide, is fully exposed, and where at all times there is a large deposit of putre- 
fying vegetable and animal remains, and that, from the decomposition of these 
remains, there arose "a miasmatic constitution of the atmosphere," "from the 
inhalation of which those individuals contracted the fever, resulting in the 
death of two of them." ' Surely, to those who know what the results of the 
exposure of such remains to the action of a powerful sun commonly are — espe- 
cially during a summer season such as that through which we passed last year, 
with an average several degrees higher than usual — the sickness of the indi- 
viduals mentioned will not appear difficult to explain, without having recourse 
to an epidemic influence stealthily creeping along the wharfs, and whose exist- 
ence is founded on purely hypothetical grounds. 

"Of course, some will feel inclined to say that, in the supposition of the cases 
in question having arisen from the action of the local causes mentioned, it is 
difficult to understand how the disease, instead of spreading, should have been 
so restricted as to attack only three individuals, and leave the rest of a large 
population unscathed. To this it may be answered, that in every place where 
the yellow fever makes its appearance epidemically — whether it be in this or 
other cities — many more escape than are attacked, except in times of violent 
and wide-spreading visitations; that, in the instances before us, the cases oc- 
curred towards the latter end of September, and but a few days before the 
occurrence of frost, or cold weather; — therefore, shortly before the close of the 
epidemic — and when, consequently, the disease had but little chance of spread- 
ing ; and that, explain them as we may, such instances of the limitation of the 
disease to a few cases, even in instances when its local origin cannot be doubted, 
are of rather frequent occurrence. Sporadic cases of yellow fever, in various 
cities and towns subject to the disease, have been noted from time immemorial. 
In some places, indeed, they occur almost annually, between periods of epi- 
demics. Nay, I could, if necessar}'', show that, in localities where the fever 
has never or seldom assumed the epidemic character, sporadic cases are not 
unknown. Now sporadic cases are as surely the effect of a poison evolved from 
local sources of infection, as those that occur in epidemic seasons ; and, if we 
admit this, we can very well admit, also, that the disease which broke out last 
year in the northern part of this city, towards the close of September — though 
affecting but three individuals out of a population of many thousands — may have 
been just as well the result of a poison exhaled from local sources of infection, 
as if it had spread to a large number, or invaded the entire district. 

" It may be remarked, before closing this branch of the subject, that instances 
of the sudden appearance, in epidemic seasons, of cases of the disease at a more 
or less considerable distance from the infected district, without the possibility 



1854.] 



Yellow Fever in Philadelphia in 1853. 



203 



of tracing them to exposure to the tainted atmosphere of the latter, are not 
unknown. Those of us who witnessed the epidemic of 1820 must remember, 
that after the disease had prevailed for some time in the parts originally and 
principally affected — first about Race Street wharf, and subsequently and 
mainly about the foot of Walnut Street and the vicinity — ^and when it was 
there on the decline, it suddenly broke" out, on the 18th of October, in the 
Northern Liberties, a mile or more from Walnut Street. The cases were twelve 
in number, of whom eleven died. They could not in any way be referred to 
the morbific agency of the atmosphere of the localities where the disease had 
before been prevailing, and w^ere satisfactorily traced to exhalations issuing 
from Pegg's Run, which at that period was unculverted, and received the con- 
tents of the gutters of numerous streets and alleys, as also of two culverts, and 
the offals of several glue, starch, dressed skin, and soap manufactories, of 
slaughter-houses, privies, &c." 

To the various reasons already assigned for the disbelief that the Mandarin, 
was instrumental in introducing the disease, Dr. La Roche adds that he has 
reason to believe that cases occurred prior to the I9ih of Jidy, "which exhibited 
many of the characters of the fever about to prevail epidemically. Of one case 
I am positively certain. It was as well marked as any I heard of or saw during 
the course of the season, and as such deserves to be recorded in this place. I 
am indebted for an account of it to the attending physician. Dr. Keating. 

'James Kiddell, £Et. 47, Englishman, a measurer of mahogany, residing in 
Fourth and Spruce Streets. I was called to see him on the evening of Monday 
the 4th of July. He had been complaining since the 1st, and had felt so unwell 
as not to attend to his regular occupation. 

' Symptoms when I first s'aw him: violent pain over the colon ; intense burn- 
ing in epigastrium; tongue very red and furred, rather contracted; expression 
of face anxious ; extreme cephalalgia, slight nausea, and a constant desire to go 
to stool, attended with tormina and tenesmus ; evacuations, M'hen I saw them, 
fecal and abundant ; heat of skin intense ; pulse 120, hard and contracted. 

'■Tuesday, July 5, at 9 A.M. Passed a very restless night; skin very hot; 
pulse increased in frequency ; burning in epigastrium very much increased ; 
tenderness over the colon almost disappeared. Has had constant recourse to the 
close stool, having had seven evacuations since I saw him. Passages consist 
now of a sero-mucus tinged with blood and semifecal matter, but abundant in 
quantity. Cephalalgia and anxious expression of face, and nausea increased ; 
but, with all this, the patient seems to have no uneasiness as to the result, and 
does not complain much of his sufferings. 

' E ceiling. Pulse and general condition same as in the morning; more flush 
in the face ; constant vomitings of a glairy mucus, some of it having chocolate- 
coloured grounds; stools more frequent, quite abundant, and consisting of a fluid 
of tarry consistence and dark purplish colour, resembling broken-up clots of 
blood; pain over the intestines, tormina, and tenesmus disappeared. Says he 
feels better. 

' Wednesday, A. M. Face has the dusky flush of typhus fever ; tongue 
red at the edges, brown and dryish in the centre ; pulse very quick, not quite 
as strong. Has been vomiting a quantity of coffee-ground, chocolate-coloured 
ffuid, and passing large masses from the bowels, resembling broken clots of 
})lood mixed with feces and mucus. Dr. West saw him with me at 12 M. on 
Wednesday. Continued very much in the same way until Friday morning, 
when all his bad symptoms apparently gave way. Got up at 10 o'clock, stood 
before the glass and shaved himself. On that day. Dr. West and myself con- 
sidered him convalescent. But at 9 o'clock P.^M. 1 was called in haste, wdien 
I found Mr. Kiddell vomiting large quantities of claret-coloured fluid; his pulse 
was rapid and sinking, and he was constantly purging a dark-coloured fluid. 
Complained of no pain ; brought up the fluid from his stomach without any 
effort. It seemed almost a regurgitation. 

'Mr. K. died Saturday morning at 9 A.M., after having had two convulsive 
spasms. I saw him a half hour previous to his demise; he complained of no 
pain, and insisted that he was convalescing. His skin was now slightly jaun- 
diced; the conjunctiva much injected; mouth filled with purple-coloured sordes. 



204 



Bihllographical Notice!^. 



[July 



A few hours after death the skin assumed a deep bronze colour. A post mortem 
was refused.' 

This case, to say the least of it, Dr. La Roche justly remarks, "is highly 
interesting. For my part, I cannot but consider it as one of yelluw fever. At 
any rate, it does not look like anything else, and certainly presents so many of 
the characteristic phenomena of that disease, that, had it occurred but a few 
weeks later, it would not have been viewed in any other light by the most expe- 
rienced physician. The dysenteric complication is far from being an unusual 
one, audits occurrence is not sufficient to change the diagnosis. It constituted 
a prominent feature in the case of Mr. Crowell, which occurred on the 16th of 
August, and terminated fatally with decided black vomit on the 19th. In the 
instance before us, we have the peculiar headache and anxious expression of 
countenance, the frequent and contracted pulse, so common during the stage 
of reaction; the intense burning of the epigastrium; the red, contracted, and 
furred tongue; the chocolate, claret-coloured, coffee-ground discharge from the 
stomach; the tarry, dark-purplish, bloody stools; the jaundice ; the bronzed 
appearance of the skin a few hours after death; and, on the third and fourth 
day, so sudden and complete a cessation of all the bad symptoms, and so re- 
markable a retention or return of muscular strength as to induce the physicians 
to regard the disease as effectually mastered. This assemblage of phenomena, 
so strongly characteristic of the yellow fever, is not encountered in any other 
febrile atFection ; and I can have no doubt that, were the description of the case 
inserted in the same monograph with those of other cases of undeniable yellow 
fever, without reference to the time at which it occurred, Mr. Kiddell would not 
be supposed to have died of any but the genuine disease. 

"The conclusion will appear the more natural when we take into consideration 
the period of the year at which the case occurred; the high range of the ther- 
mometer at the time and for many Aveeks previous ; the localities the patient 
had visited, and the circumstance that, but a few days after, many other cases, 
as regards the yellow fever nature of which there can be no difference of opinion, 
showed themselves. 

" During the progress of the case, I was made acquainted with the phenomena, 
and I saw the body an hour or two after death. Dr. Keating recollects full well, 
that I expressed several times the opinion that the disease was one of a very 
suspicious character; that I stated that, if there were cases of yellow fever in 
town, I should feel no hesitation in reporting the one in question as of that kind, 
and that he had better watch it closely lest it might slip out of his hands before 
he was aware of danger. He recollects, too, that, when I heard of the sudden 
and remarkable remission on the third or fourth day, and afterwards saw the 
body, I was still more disposed to believe he had had to deal with a case of 
yellow fever, and that I strongly urged the propriety a post-mortem examina- 
tion, when, I felt convinced, the liver, stomach, duodenum, and small intestines 
would be found to present the anatomical characters appertaining to that disease. 

"Entertaining these views respecting the nature of the foregoing case, I can 
have no hesitation in regarding it as an avant co^ireur of what was about to hap- 
pen — as a foreshadowing of the approaching epidemic. Whether or not many 
€ases of a similar kind, or of a more mitigated character, occurred about the 
same time, and prior to the 19th of July, is more than I shall undertake \o 
decide positively. But, considering that all the cases of yellow fever that ended 
fatally during the season, especially at the commencement, were not reported 
as such to the Board of Health; that the disease, being new to most of the prac- 
titioners of the city, may easily have been mistaken for something else ; that 
such may more particularly have been the result in mild cases, and that very 
few of those that recovered from an attack of the real disease were reported at 
all, we can have no certainty that the case of Mr. Kiddell forms a solitary ex- 
ception to the rule, and was the only one that presented itself prior to the arrival 
pf the Mandarin and the outbreak of the disease at South Street wharf. 

" Let it be observed, in addition, that doubts may b« raised as to the correct- 
ness of the dates at which the attacks of some of the early cases recorded are 
said to have occurred. In regard to one of them, at least, some uncertainty 
exists ; for while he is stated, on information obtained at his boarding-house, to 



1854.] 



Yellow Ftver in PMladelpliia in 1853. 



205 



have been seized on the evening of the 20th, he hiraself-^and we should suppose 
he knew something about the matter — affirmed at the hospital, where he was 
removed, that he sickened on the ITth. 

" But be this as it may; whether the case of Mr. Eiddell was or was not the 
only one of the kind that occurred before the arrival of the Mandarin, at South 
Street wharf, matters little as regards the question before us ; provided it be 
admitted, and I cannot conceive how any doubts can be entertained on the sub- 
ject, that the disease of which he died was similar to that which subsequently 
spread epidemically, my object will be attained. In that event, the case in 
question must have been due to the action of the same poison which produced 
all the cases that appeared some days afterwards; and its occurrence early in 
July, shows indubitably that that poison floated, to some extent, af least, in the 
atmosphere of the wharves prior to the arrival of the Mandarin; and that, con- 
sequently, we are to look, not to the bilge-water of that vessel, but to other 
sources of infection, to account for the existence of the fever among us last 
summer. Sach foreshadowings are not uncommon. They have been noticed 
in many of our epidemics, and in those of other places, where it was observed 
that the disease commenced with a single, or a very few cases ; and that, after 
the recovery or death of these, it made a remarkable though partial pause. This 
pause was noticed as regards the early epidemics of this city, by Dr. Currie and 
Dr. Rush. It was dwelt upon in an especial manner by the late Dr. Hosack, 
who stated that it occurs in every visitation of the fever, and fixed its duration 
at from eight to twelve or fourteen days. 

"Another and very strong reason for doubting, if not denying, the agency of 
the Mandarin in the producj^ion of the fever of last year, is derived from the 
circumstance that we are called upon to believe that an epidemic which lasted 
— as epidemics of yellow fever usually do here, and in other parts of temperate 
regions — nearly three months, was thrust upon us by a vessel which did not remain 
in port more than a week after the discharge of her cargo ; which is yet to be 
proved to have communicated the disease to a single individual who visited or 
worked on board of her, and which is admitted by all parties to have been per- 
fectly innocuous after she left Almond Street. In a word, we are given to un- 
derstand, that a fever, which continued to prevail a very long while after a vessel 
left the wharf where her cargo was discharged, was nevertheless introduced 
among us by that vessel. That this vessel deposited, during the few hours she 
remained at the wharf after she was emptied, a poisonous agent of some sort, 
which continued to thrive and spread its baneful effects after the departure of 
the instrument of its introduction; and that the latter, after making the fatal 
deposit, and being removed from the spot it had helped to contaminate, ceased 
to be itself a focus of infection. The occurrence, in so far as regards the yellow 
fever, does not appear to be probable, and would, if true, be in direct contra- 
diction to the result of former experience here, and in many places where the 
disease has often been observed. 

In conclusion. Dr. La Roche observes : " If the facts and arguments that have 
been presented in the foregoing pages are entitled to the value I attach to them, 
we may conclude that the origin of the yellow fever which, after an interval of 
more than thirty years, visited this city last summer, can in no wa}^ be ascribed 
to a poison issuing from the barque Mandarin, and contaminating the surrounding 
atmosphere ; but must be viewed as the product of exhalations from sources of 
infection existing in the localities where the disease appeared.^' 

We have thus given as full an abstract of the important paper of Dr. La 
Roche as our limits will permit. Those who are specially interested in the sub- 
ject, should refer to the paper itself, in which they will find many additional 
arguments in support of the opinion he maintains. We have quoted, however, 
sufficient to prove that Dr. La Roche brings to the consideration of this question 
a sober judgment, a well-disciplined mind, and a thorough acquaintance with 
the whole literature of the subject, which entitle his views to a respectful con- 
sideration, and that they should not be rejected until equally conclusive and 
well-observed facts can be adduced in opposition. 
No. LY.— July 1854. 14 



206 Bibliographical Notices. [July 



Art. XXIII. — The Mastodon Giganteus of North America. Bj John C. "Warren, 
M. D., late Professor of Anatomy in the University of Cambridge ; President 
of the Boston Society of Natural History ; Member of the American Philo- 
sophical Society ; of the American Academy of Arts and Sciences ; of the 
Philadelphia Academy of Natural Sciences ; of the Academy of Naples and 
Medical Society of Florence ; Honorary Member of the Medico-Chirurgical 
Society of London ; Corresponding Member of the Academy of Medicine of 
Paris, "&c. &c. Boston, 1852. 4to. pp. 219. With twenty-seven Plates. 

Address to the Boston Society of Natural Historij. By John C. Warren, M. D., 
President of the Society. Boston, 1853. 8vo. pp. 48. 

Remarks on some Fossil Impressions in the Sandstone Rocks of Connecticut River. 
By John C. Warren, M. D., &c. Boston, 1854. 8vo. pp. 54. With a Plate. 

The Preservation of Health. With Remarks on Constipation, Old Age, and Use 
of Alcohol in the Preparation of Medicines. By John C. Warren, M. D., &c. 
&c. Boston, 1854. 8vo. pp. 140. 

The professional annals of our country do not, we believe, furnish a brighter 
example of long-continued industry and devotion to the improvement of our 
science than is afforded by the author of the above works. For half a century 
engaged in extensive practice, both hospital and private, he has, nevertheless, 
found time to record for the improvement of his brethren and for the benefit of 
mankind, the results of his large experience ; and even now, though he has ac- 
complished enough to satisfy the ambition of most men, and has arrived at 
an age when repose might be supposed desirable; and further, though suffer- 
ing, we regret to learn, from impaired health, he still devotes his energies 
with a zeal which would be worthy of youth to the advancement of the 
profession he has so long adorned, and even pushes his researches into other 
fields of science, and contributes by his labour to their cultivation and im- 
provement. 



1854.] 



207 



aUAETERLY SUMMAEY 

OF THE 

IMPROVEMENTS AND DISCOVERIES 

IN THE 

. MEDICAL SCIENCES. 



ANATOMY AND PHYSIOLOGY. 

1. Strudure of the Spleen. — In the sixth number of the Quarierly Journal of 
Microscopic Sciences, Mr. Hu-slet gives an account of his recent investigation 
into the structure of the splenic Malpighian bodies. From these it results, 
that one or more minute arterial twigs enter and frequently subdivide in the 
substance of the Malpighian body, making their exit on its opposite side, to 
terminate finally by breaking up into minute branches in the pulp. The 
artery is not only surrounded by, and in immediate contact with, the in- 
different tissue of the pulp, but the latter is really the representative of a part of 
its tunica adventitia. The vessels within the Malpighian bodies are, however, 
not arterial ramifications only, as there is, in addition, a tolerably rich network 
of capillaries connecting the arterial ranuncuies. 

Mr. Huxley has not been able to convince himself of the existence of any 
fluid matter at all in the interior of perfectly fresh Malpighian bodies of any 
animal he has examined. These bodies appear to him solid, though soft ; and 
to have an essential structure the same as that of every " indifferent tissue" he 
has examined, and not composed of cells, although here and there true cells 
are to be discerned. 

In the human spleen, the Malpighian bodies, cannot be said to possess walls ; 
the tissue at the line of junction with the pulp not forming a distinct mem 
brane; and Mr. Huxley cannot see the membrane and other limitary structures 
which Mr. Sanders has so circumstantially described. On this discrepancy we 
may remark, in the words of a learned judge, that "those who see it, cannot 
see it unless it be there ; and those who do not see it, cannot see it all." 

It ma,y be said, then, that the Malpighian bodies of the mammalian spleen 
are not closed follicles, and have no analogy whatever to the acini of ordinary 
glands, but that they are portions of the spleen, everywhere continuous with, 
the rest, but distinguished from it by immediately surrounding the arteries, 
and replacing their tunica adventitia, by containing no wide venous sinuses, 
and by being composed of absolutely indifferent tissue. 

Mr. Huxley considers also, with Leydig, that no line of demarcation can be 
drawn between the spleen, the lymphatic glands, Peyer's patches, the glandulse 
solitarige of the intestine, the suprarenal capsules, and the thymus gland, of 
which " vascular glands" the primary form is represented by the intestinal soli- 
tary gland, which is nothing but a local hypertrophy of the indifferent element 
of the connective tissue of the part, and possesses no other capsule than that 
which necessarily results from its being surrounded by the latter. To these 
the follicles at the base of the tongue and in the tonsils must be added ; and 
Mr. Huxley thinks that from these there is but one step to the liver. 



208 



Progress of tlie Medical Sciences. 



[July 



2. Vascular Tissue of the ScJmeiderian Mucous Membrane. — Dr. Kohlrausch 
published in Muller's ArcMv. (1853, H. 2) a description, with figure, of what 
he designated as an erectile tissue, lying between the mucous membrane and 
the periosteum of the turbinated bones, especially at their posterior aspect. 
It is a venous plexus, which can be exhibited by insufflation or by injection,, 
consisting of loops of venous twigs, running vertically to the bone, and closely 
connected by firm areolar tissue. The mucous follicles, which, in other parts 
of the nasal mucous membrane, are quite superficial, and have short funnel- 
shaped openings, lie here more deeply between the meshes of the venous net- 
work, and discharge their secretion through longer ducts. 

This peculiar arrangement of the vessels of the Schneiderian membrane ac- 
counts for the profuse hemorrhage which so often occurs from the nose, as 
well as for the sense of fulness and tension within that organ, and the copious 
sero-mucous discharge from it, which are well known as ordinary symptoms of 
coryza. — Assoc. Med. Journ. March 24, 1854. 

3. Mucous Membrane of the Stomacli. — The Zeitsclivlft fur Baiionelle Medizin 
contains a paper by Ecker on the glandular apparatus of the gastric mucous 
membrane, which he examined shortly after death in the bodies of several 
young men who had committed suicide. The account he gives is as follows : 
In the middle part of the stomach, there are only simple cylindrical glands, 
each from half to three-quarters of a line in length, and about one-fiftieth of a 
line in diameter. They lie vertically, and are somewhat club-shaped at the 
closed extremity, just, in fact, as Sharpey and others have descrilDed them. 
The mucous membrane of the cardiac end of the stomach is composed of similar 
follicles ; only many of them are bifurcated at the end. In the pyloric portion, 
we find, besides these, granular-looking bodies, which are glands somewhat 
resembling those of Brlinner in the duodenum, and the ducts of which branch 
and end in grape-like vesicles. The function of these glands is, no doubt, to 
furnish mucus for the lubrication of the pylorus, where the bolus of food is 
necessarily most consistent. Besides all these, we meet with "lenticular 
glands,^^ resembling the solitary follicles of the intestine, which have a diameter 
of from a quarter to three-quarters of a line, and are least abundant along the 
great curvature of the stomach.— Med. Journ. March 24, 1854. 

4. The Anatomy and Surgical Relations of the Fascia of Scarpa. — Mr. J. 
Struthers states [Monthly Journ. Med. Sci. May, 1854), that the fascia of Scarpa 
is not commonly understood fully, in the simplicity of its anatomy and the 
importance of its surgical bearings. In the common mode of conducting the 
dissection of the groin, he maintains that the true origin of the fascia is divided, 
and its nature and connections cannot be seen or understood. lie gives the 
following directions for demonstrating this fascia: "Having reflected the skin 
of the groin for some inches both above and below Poupart's ligament, divide 
the superficial fascia of the thigh two or three inches below Poupart's ligament, 
and, using the point and handle of the scalpel, turn it up, off the surface of the 
glands and superficial vessels, to about an inch above Poupart's ligamento 
Next, by an incision curving down from the anterior-superior spinous process 
of the ilium to near the symphysis pubis, divide the fascia through its whole 
depth, down to the tendon of the external oblique ; and now dissect the whole 
fascia down, close off the external oblique. The lax cellular tissue here, yields 
almost to the handle of the scalpel, but at, or immediately below Poupart's 
ligament, the handle of the scalpel is suddenly and firmly arrested. The dis- 
section is now done. Now take the femoral end of the dissected superficial 
fascia in one hand, and the abdominal end in the other hand, lifting them up a 
little, and stretching them up and down, and, on looking in below, a thin semi- 
transparent fibrous membrane is seen, passing between the superficial fascia 
and the fascia lata. This is the fascia of Scarpa, fully displayed; but if the 
glands and surrounding cellular tissue be now carefully picked away from its 
lower or femoral aspect, the fascia will be more clearly seen." 

Mr. Struthers gives the following description of this fascia: — 

^' The fascia of Scarpa arises from the fascia lata close below Poupart's liga- 



1854.] 



Anatomy and Physiology. 



209 



ment, passes upwards for an inch, and blends with the common superficial 
fascia. It is separated from the lower part of the tendon of the external ob- 
lique, behind, by very loose cellular tissue, and, before, from the common 
superficial fascia by the superficial glands and vessels ; and is continued 
inwards around the cord, becoming continuous with the fascia of Colles, or true 
superficial fascia of the perineum. It is a thin aponeurotic or fibrous mem- 
brane, forming a barrier or septum across the groin, by passing between the 
fascia lata and the common superficial fascia. When the urine, infiltrated in 
the perineum, has been directed upwards along the cord by the fascia of Colles, 
the fascia of Scarpa prevents it from passing down the front of the thigh. In 
relation to hernia, it assists in directing an inguinal hernia into the scrotum, 
and forms one of its coverings ; it is covered by a femoral hernia, and tends to 
prevent the femoral hernia from passing upwards on the abdomen, by means 
of its union with the common superficial fascia." 

5. The Process of Bepair in Teeth. — The recent number of Gin/s Hospital 
Reports, contains a very interesting communication by Dr. S. J. A. Salter, on 
the laws which regulate the formation of the " Dentine of Repair," one of the 
forms of what has been called secondary dentition, or that after formation by 
which the pulp cavity of the tooth is diminished or obliterated, after the tooth 
has attained a mature and adult condition. 

There are three forms of secondary dentine: Osteodentine, in which the new 
tissue is arranged in systems resembling the Haversian systems of bones 
around isolated vbloodvessels ; the dentinal tubes radiating from each centre. 
It always occurs in states of- irritation or inflammation of the pulp. Dentine 
excrescences are little nodules of secondary dentine, occasionally found attached 
to the interior of the pulp cavity of otherwise healthy teeth. Dentine of repair 
is the special subject of the paper. This deposit is thrown out within the pulp 
cavity, opposite to that part of the external surface of the tooth where a fracture 
or wearing of the original dentine has taken place, thus thickening the body of 
the tooth opposite the injured part, so that teeth which are worn down even 
level with the gum still present no cavity. 

This process corresponds with the most beautiful exactness to the external 
lesion ; as long as the enamel only is injured, no dentine of repair is deposited; 
but as soon as any of the dentine tubes are broken oflP or worn away on the 
surface of the tooth, so soon is there thrown out at their opposite extremities 
towards the pulp a deposit, limited with the utmost exactness to the injured 
tubes; not mathematically opposite, therefore, to the injured part, but^^^^io- 
logically opposite, according to the wavy course of the tubes. The dentine of 
repair is clear and translucent, and the part of the original dentine involved 
in the process becomes also more transparent than usual, in consequence of its 
tubules being filled up with solid matter. 

6. Elasticity of Arteries considered as a Cause of Animal Peat. — Dr. Winx 
read before the Physiological Section of the Medical Society of London (May 8, 
1854), a paper on this subject. The author stated that fourteen years since 
he had published, in the Philosophical Magazine, some observations which 
tended to prove that the elasticity of the arteries formed an important element 
in the generation of animal heat. About seventeen years since, while making 
some experiments with caoutchouc, he was forcibly struck with the property it 
possesses of evolving heat when suddenly elongated, and was led at the time 
to infer the probability of other bodies being similarly endowed. The elastic 
coat of arteries, especially, appeared to be one of the substances likely to ex- 
hibit this calefactory principle ; and, in the event of this being the case, he 
thought it would not be unreasonable to conclude, that the incessant contrac- 
tions and dilatations of the arteries during life must form an eflficient source of 
animal heat. Three years subsequently he was induced to resume the sub- 
ject, and, upon making an experiment with part of the aorta of a bullock, he 
was much gratified in being able to verify his previous conjecture. The experi- 
ment was performed as follows : Having cut oflF a circular portion of the 
descending arch of the aorta, about an inch in length, he laid it open and care- 



210 



Progress of tlie Medical Sciences. 



[July 



fully removed its external and internal coverings. He then pulled it to and 

fro with a continuous jerking motion, in imitation of the systole and diastole of 
the artery, for the space of about a minute. Immediately on discontinuing 
this movement, he placed it upon the bulb of a thermometer, and had the satis- 
faction of noticing, after the lapse of tvro minutes, that the mercury had risen 
as many degrees. On removing the thermometer, the heat diminished rapidly. 
To be certain that the increment of heat was not derived from any source other 
than that in question, he took the precaution of covering his fingers with a 
double layer of flannel, to prevent the communication of heat from the body. 
He also covered his mouth with a handkerchief, to guard against the warm 
breath affecting the thermometer while watching the progress of the experi- 
ment. It may also be right to state that the experiment was performed in a 
room without a fire, the temperature of the air being 55°. There were several 
diflBcnlties to contend with during the investigation. The chief impediment 
appeared to be the moisture of the artery, which, by its evaporation, had a 
tendency to carry ofi" a portion of the heat. However, by carefully drying the 
artery with a cloth, he succeeded in obviating this difficulty to a considerable 
extent, and was enabled to perform the experiment twice consecutively in a 
satisfactory manner. He had also, within the last fortnight, repeated the ex- 
periment in the presence of a medical friend, with an equally satisfactory 
result. His attention was often arrested, while conducting the experiments, 
by other mechanical analogies between caoutchouc and the elastic coat of 
arteries. Like the former, the latter could be elongated to twice its ordi- 
nary length, and, on suddenly stopping the tension, would return to its 
usual dimensions with considerable force and a snapping noise. Physiolo- 
gists, after having clearly proved that a great portion of animal heat is 
the result of chemical changes in the blood, yet confessed that a residuum 
of heat is not to be referred to this source. This residuum, he considered, 
arises from the mechanical action of the arteries. It would be exceedingly 
difficult to determine the precise quantity of heat given off during each beat of 
the artery : but if we admit the development of only a very small quantity, it 
necessarily follows, from the circumstance of the action of the arteries being 
in incessant operation during life, that the heat must quickly accumulate to a 
great extent; and it is even probable that the body, unless cooled by the func- 
tions of the skin and lungs, would, in a short space of time, become preter- 
naturally hot. The following physiological and pathological facts appear to 
corroborate the views he had taken as to the mechanical source of heat: 
1. The minute distribution of the arteries to every part of the system insures a 
general and equal distribution of heat. 2. The rigidity of the arteries in old 
age is a probable cause of the diminution of animal heat at the close of life. 
3. The increased warmth of the body after exercise seems to be readily expli- 
cable upon the principle of increased force of the arteries. 4. In many diseases 
of the lungs, where their functions are at fault, and at a time when the arteries 
are beating with great strength and velocity, the heat of the body is found to 
be above the usual standard. 5. Medicines which diminish the action of the 
heart and arteries almost invariably reduce the temperature of the body. 
6. The heat of local inflammation, in cases where the constitution does not 
sympathize to any extent, cannot be satisfactorily referred to any other source, 
as the arteries immediately in the neighbourhood of the affected part are' 
throbbing violently, when the capillaries (which are supposed to play so large 
a share in the chemical theory) are generally considered to have their action 
impeded. Dr. Crisp has hinted that many cold-blooded animals are remark- 
able for the great elasticity of their arteries. This fact could not affect his 
theory. The languor of the circulation in this class of animals more than 
counterbalances any calefactory effect which might otherwise be produced by 
the resiliency of their arterial structure. — Med. Times and Gaz. May 27, 185-i. 

7. Starch in the Brain. — In our previous number, p. 4C6. we gave an account 
of the discovery by Purkinje and Yirchow of starch globules in the human 
nervous centres. Mr. Busk states [Microscopic Journal, number 6) that he has 
satisfied himself of the structural and chemical identity of these bodies with 



185i.] 



Anatomy and Physiology. 



211 



starch. He found these " corpora amylacea" in vast numbers in and on man j 
parts of the brain (as on the septum hicidum, for example), in a patient who 
had died of cholera ; and the cerebral substance in immediate contiguity with 
them appeared quite natural. 

In the corpora striata he could find few or no starch grains, but an appear- 
ance presented itself which seemed to him to be connected with their forma- 
tion. Many particles of sabulous matter were met with, which were lodged in 
irregular masses of what appealed a fibrinous or immature connective tissue 
substance; and, upon the addition of iodine, each mass of crystals was found 
to be immediately surrounded by an irregular thickness of a transparent mat- 
ter, which was turned, not hlue, but a light purplish pink by that reagent — a 
substance, in fact, closely resembling in that respect the Tery early condition 
of the cellulose wall. 

8. On tJie Belaiion tliat Fat hears to the Presence of Sugar in tlie Livers of 
the Mammalia and Birds. — Dr. Gibb, in a paper read before the Physiological 
Section of the Medical Society of London ( April 10, 1854), drew the atten- 
tion of the Society to the bearing which the amount of fat in the livers of man 
and animals, and birds, possesses in relation to the presence of sugar in that 
organ, which may hereafter lead to some important deductions with reference 
to its pathology in connection with saccharine assimilation. From a series of 
experiments which he had performed upon the livers of birds and some of the 
mammalia, from 1S49 to 1S52, with the original object of estimating the quan- 
tity of sugar present, he found that those which possessed much fat invariably 
contained a larger quantity--of sugar than those, again, which appeared to pos- 
sess very little, if any, of that substance. Thus, among the mammalia, in dogs 
and sheep, whose livers possessed nothing unusual in their ordinary characters, 
the presence of sugar was demonstrated, but in quantity exceedingly small, as 
compared with that found in the seals, whose livers again were absolutely 
gorged with fat, and contained a very large quantity of sugar. Among birds, 
the livers of- the palmipedes, or web-footed tribes, and the gralU"© or waders, 
which, in most of the species, contained quantities of fat, were found to possess 
a much larger quantity of sugar than the livers of the gallinge, or poultry, 
which were remarkable again for the absence of fat, as compared with the 
former. To apply this discovery to man, he instituted a comparison in regard 
to the quantity of sugar between healthy livers and the state termed "fatty 
liver,^^ common in phthisis pulmonalis, and experiments clearly proved that 
the amount of sugar found in the fatty liver very much exceeded that of the 
normal healthy liver. These experiments were repeated with the same results 
on numerous occasions, with the examination also of other organs besides the 
liver, but which would not now be noticed. The importance which the know- 
ledge of this fact is likely to bear, in connection with the secretion of fat and 
sugar by the liver, their relations to one another, and their connection with 
the function of respiration, cannot be over estimated. Bernard has clearly 
demonstrated the presence of sugar in the hepatic veins going from the liver, 
the inferior vena cava, and right side of the heart ; in other words, in the blood 
going to the lungs, but none in that returning from those organs, unmistak- 
ably showing that the saccharine element must undergo some chemical change 
in the lungs, as has been inferred by Magendie. He was not prepared to say 
what influence the presence or absence of fat may possess in relation to the 
secretion of sugar in the liver, but it is a fact of sufficient importance to engage- 
the attention of physiologists in connection with saccharine assimilation. The 
fact, too, of more sugar being found in the "fatty liver'^ of phthisis than in the 
healthy liver, may possibly be the result of the interference of the ordinary 
combustion of the lungs, owing to the arrest of function in portions of those 
organs, arising from the tubercular deposition. He would only just hint, at 
present, at a possible relationship between secondary mal-assimilation of sac- 
charine matters and tubercle, but some further experiments are necessary 
before pronouncing an opinion. 

Dr. Gibb has not examined the liver of diabetic patients in relation to the 
quantity of sugar contained in that organ. 



212 



Progress of the Medical Sciences. 



9. On tlie Deposit of Fat in certain Conditions of tlie Bodies of tJie Loiver 
Animals. — Dr. Crisp directed the attention of the members of the Physiological 
Society (March 13, 1854) to the above fact, which, as far as he knew, had 
hitherto escaped observation. A short time since, a Chilian eagle, which had 
been seventeen years in the Regent's Park Zoological Gardens, died suddenly- 
from rupture of a bloodvessel in the lung. The bird was in beautiful plumage, 
in good condition, and weighed 6| lbs. Dr. Crisp found the lungs so tuber- 
culated that scarcely a sound portion could be seen ; notwithstanding this ex- 
tensive pulmonary lesion, the bird was excessively fat; the flakes of fat in the 
pelvis and abdomen being large and solid. Dr. Crisp had met with many in- 
stances of a similar kind, more especially in birds; but they were not confined 
to this class of animals, for he had seen many examples of fat pigs wich tuber- 
culated lungs, and he had learned from some feeders of cattle that an ox with 
a damaged lung would often make fat sooner than a sound animal. Perfect 
rest, however, was necessary; and it should be borne in mind, that if the tho- 
racic lungs of a bird were diseased, other parts of the body would take on a 
compensatory action. Dr. Crisp thought that the explanation of the phenome- 
non, in these cases, was, that the carbon not being eliminated by the lungs was 
converted into fat by its union with hydrogen and oxygen. In making a com- 
parison between pulmonary tubercle in man and the lower animals, it is im- 
portant to remember that the latter are not affected with the exhausting puru- 
lent discharges which generally occur in the human species. 

Dr. Houth could understand the theory of the beneficial action of cod-liver 
oil in cases of phthisis, but was of opinion that Liebig's theory, as to the gene- 
ration of fat in that disease, was not established. The respiratory eS'orts are 
increased to forty per minute in phthisis; and the amount of carbon and hydro- 
gen eliminated is so great that a deposit of fat seemed to be impossible. The 
like remarks would also apply to birds, since their respirations are exceedingly, 
frequent. — Med. Times and Gaz. April 1, 1854. 

10. Bernard, 071 Conditions under whicli Certain Substances, usually retained 
in the Blood, pass into the Urine. — During active digestion, the blood of an ani- 
mal contains a certain amount of sugar, which does not pass into the urine ; 
but if the mass of blood be diminished by bleeding, the urine soon becomes 
saccharine. If we inject a limited quantity of saccharine matter into the 
blood of an animal (2- gramme for a rabbit fasting, of the weight of 2 kilo- 
grammes) the urine will contain no trace of sugar ; but if the animal be bled 
before being subjected to this experiment, a certain quantity of sugar will pass 
into the urine. 

M. Bernard explains these phenomena by considering that the loss of blood 
renders the animal of less volume, reducing it to the condition of one of smaller 
size. It is known that small animals may be poisoned by doses easily borne 
by larger animals of the same species ; and animals, after being bled, cannot 
withstand the same dose of a poison which they supported previously. These 
facts were formerly attributed to the increased absorption caused by the with- 
drawal of blood ; but in the experiments above related, absorption had no part, 
as the substances were introduced directly into the circulation. — Month. Joitrn. 
Med. Sci. from Soc. de Biologic, 1853. 

11. Case of Diarrhoea Adiposa, confirmative of Bernard's Vieics with Eegard 
to the Functions of the Pancreas. By Mr. Marstox. — This case was that of a 
man, a labourer, aged 35, who had frequent purging of a very peculiar fatty- 
looking substance. No tenderness, swelling, or tumour could be detected, ex- 
cept a slight enlargement of the liver. 

" His appetite was good, and he had a great desire for saccharine matters, 
fat meat, and hydro-carbons generally. Urine was passed in abnormal quan- 
tity, pale in colour, with very slight reaction on litmus; sp. gr. 1,030. Under 
the microscope it presented a few epithelial scales, and a number of oil glo- 
bules ; on evaporating a portion, and treating it with ether, these globules were 
dissolved; there was less than a normal amount of urea and lithic acid, and no 



1854.] 



Anatomy and Phi/sioloyy. 



213 



albumen; but Trommer's test, yeast, and oxide of silver, indicated the presence 
of sugar, and the skin was harsh and dry, though he did not compLiin at all of 
these diabetic symptoms, all of which disappeared some time before death. 
Tongue was slightly furred ; gums, and inside of lips, were pale and flabby. 
Pulse 100, but it varied during treatment from 90 to 120. No cancer, phthisis, 
or cardiac affection could be traced in any of his family, which had been gene- 
rally healthy. The matters passed from the bowels presented a very fatty, 
tenacious, and peculiarly slimy, appearance, deficient in bile, and altogether 
different from feces. On raising a portion on the point of a knife, it appeared 
in greasy masses. Under the microscope, numerous epithelial scales, with 
mucus, and a substance laden with oil-globules, in every respect similar to fat, 
were observed. Their fatty nature was rendered more evident by their being 
soluble in ether, and with liq. potassse forming a semi-opaque gelatinous mass 
exactl}^ resembling soft soap.^-* 

The treatment consisted in abstinence from ''farinaceous and saccharine 
articles of food. Diaphoretics succeeded, though with difficulty, in producing 
diaphoresis ; the sweat had no acid reaction on litmus. Olive oil, instead of 
being beneficial, only increased the discharge of fatty matter and deranged 
the stomach. Purgatives, mercurials, and counter-irritants, with small doses 
of iodide of potassium and ung. iodin. to region of liver, and a variety of other 
remedies failing to produce relief, at last, all medical treatment wa-s discon- 
tinued. His appetite continued good, but the adipose diarrhcea (four or five 
stools per diem upon the average) continuing, he gradually sank, and died ap- 
parently from asthenia, after having been under medical treatment altogether 
thirteen to fourteen months.^' 

On dissection, the duodenum was "quite healthy, but the head of pancreas 
appeared to be converted into a hard, schirrhoid tumour, which did not press 
upon the ductus communis choledochus, as in most of the similar recorded 
cases, whilst the body and other parts of gland were atrophied, and its duct 
was found perfectly obliterated, and degenerated into an impervious cord." 

Mr. Marston concludes some excellent observations on this case with the fol- 
lowing remarks: " Mialhe, adopting Bernard's views, explains the action of 
the pancreatic juice upon the fats by the principle of fermentation. More re- 
cently, another set of physiologists, of whom Frierichs and Lenz appear to be 
the most prominent, have published a series of experiments to prove that its 
absence in the intestine does not prevent the digestion and assimilation of fat. 
They experimented upon cats, and found the usual amount of fatty matter in 
the chyle, after ligature of the pancreatic duct. Here, then, exists a division 
between two leading sects of physiologistSv^ for Bernard still adheres to his 
views. The question comes, does this case in any way fill up the gap? It has 
been advanced by Bouchardat and Sandras, that the free alkali of the juice, or 
serum of the blood, would be sufficient to dissolve the fat; and, adopting Platt- 
ner's theory, the soda of the bile may be almost vicarious of the action of the 
pancreatic juice, in separating the fatty ingesta by saponification with its acid. 
But whether this could continue long is not evident, and what appears to be 
the real root of the question is, whether, under long continuance, this would 
not be incompatible with existence. In the case before us, it is possible that 
the choleate of soda of the bile, and the alkalies of the serum, did supply an 
alkali to the fat, thus saponifying it, and that the choleic acid, if Plattner's 
views be correct, taking albumen as its base, the resulting compound, which is 
the product of so highly an organized gland as the liver, on the one hand, and 
the chemical and antiseptic action of the gastric secretion, which is doubtless 
itself not a mere chemical combination, but a definite semi-organized material, 
on the other, might give rise to the fatty albuminous molecular base of the 
chyle ; but that, this continuing, these alkalies were not only insufficient in 
quantity to the digestion of the fatty ingesta, but an imperfectl3--organized 
material was formed, from which an imperfect chyle resulted. 

"The presence of sugar in the urine in this case is difficult of explanation ; 
but be it remarked that this was a transitory symptom, existing most when the 
patient partook largely of amylaceous matters, which are easily capable of 
being resolved into sugar and ultimately ceasing altogether long prior to 



214 



Progress of the Medical Sciences. 



[July 



death. It might be that a larger than normal amount of fatty matter was 
presented to and absorbed by the tributary branches of the vena porta, and 
that, through the intermediate action of the liver (if Bernard's views be cor- 
rect), this was resolved into sugar and carried by the hepatic vein into the 
general circulation ; and, being more than normal in quantity, did not alta- 
gether undergo decomposition in the lungs (as it is conceived to do) but was 
excreted by the kidneys. Again, the deposit of fatty matter in the viscera 
generally, may admit of a similar explanation ; for, I apprehend, we must re- 
gard the fatty degeneration of the liver not as a primary affection, but as a 
secondary disease, resulting from the actual deposition of fat from the blood, 
it being found in a similar condition in almost all diseases attended by much 
emaciation. Perhaps the fatty ingesta in this case, not having been subjected 
to the vital and chemical action of the pancreatic secretion, had never reached 
a sufficiently organized state to undergo the necessary changes, prior to assimi- 
lation or secondary combustion. 

" Looking at the case in all its bearings, it certainly appears to support Ber- 
nard's views, which I cannot consider entirely overthrown by the experiments 
before quoted. — Glasgow Medical Journal. 

[This is a valuable addition to the six cases of Bright, Elliotson, Lloyd, and 
Gould, and supports, from the result of pathological observation, the experi- 
mental researches of Bernard with regard to the functions of the pancreas. 
In a memoir, published in the last number of the Prague VierteJjahrschrift, by 
Dr. Eisenmann, a seventh case is quoted by Lussanna, in th^ Giornale Veneto 
di Sc. Med. t. ii. 766, and an eighth case of his own is given. In the last two 
instances, however, the individuals recovered, the principal symptona having 
been discharge of fatty matters by stool.] — Monthly Journ. Med. Sci. Jan. 1854. 

12. The Effects of the Recumbent Posiiioyi during Syncope, physiologically con- 
sidered. — Mr. Richardson read before the Physiological Section of the Medical 
Society of London (April 20, 1854) a paper on this subject. The author com- 
menced by stating that though the fact, that the recumbent or horizontal posture 
often affords marked and immediate relief in syncope, is generally admitted, no 
very distinct attempt had hitherto been made to explain the principles on which 
it acted. One view, however, had fixed itself in the professional mind, and re- 
quired to be carefully refuted. This view is, that the horizontal posture relieves 
syncope, by allowing the blood to gravitate to the brain and medulla, so that 
these centres, gaining energy by this process, react on the heart and supply 
it with new vigour. This theory had been supported by many writers, among 
whom the author quoted Dr. Alison, of Edinburgh, Dr. Ash, and Sir George 
Lefevre. The latter author relates a case in which syncope occurred on the 
patient assuming the erect position. It was found to be connected with the 
presence of varicose veins in the leg, and was prevented by the application of 
iDandages. In this case, Mr. Richardson observed, that the brain being de- 
prived of blood was secondary to the fact that the propelling power of the heart 
w^as to a great extent lost through the mechanical impediment in the course of 
the circulation — an impediment which the bandages relieved. It was also 
obvious that the blood detained in the lower parts of the body could not reach 
the brain without first passing through the heart. Moreover, any renewed 
force which the heart might receive from the nervous centres would be quite 
useless until it contained blood on which to act. When we perform transfusion, 
we do so for the purpose of filling the heart with its natural stimulus, not for 
the immediate purpose of exciting the nervous centres. The recovery of con- 
sciousness on laying a person in the supine position is no proof of the correct- 
ness of the hypothesis above mentioned ; for, when consciousness ceases during 
syncope, it ceases as a consequence of failure of the circulation, and returns in 
proportion as the circulation becomes re-established. Mr. Richardson had 
observed that the first symptom of recovery from syncope invariably was the 
return of the heart's beat, and that then muscular motion, consciousness, and 
animal heat followed. Again, in some instances, the action of the heart fails, 
while the functions of the nervous system remain perfect ; and, on the other 
hand, the manifestations of the nervous system may be suspended by narcotic 



1854.] 



Materia Medica and Pharmacy. 



216 



poisons, while the heart continues to beat with power. There tnay also he ex- 
tensive disease of the cerebro-spinal axis, and yet the heart's action remains 
unaffected. Again, in the animal kingdom, the size of the heart and activity 
of the circulation bear no relation to the development of the nervous system ; 
and, in the formation of the vertebrate embryo, the heart begins to pulsate 
before it is connected with any nervous centres. ^Ir. Richardson next pro- 
ceeded to offer his own theory of the manner in which the recumbent position 
produces recovery from syncope. The explanation appealed to mechanical 
laws, and was very simple. It 'must be remembered, that the arterial blood 
sent from the heart first ascends, and that the venous blood descends from the 
upper and ascends from the lower parts. AV'hen blood is withdrawn from the 
upper part of the erect body, the heart loses its power of sending the blood 
along the aorta ; hence the blood, losing the vis d tergo, gravitates in the veins 
in the lower half of the body. At the same time, the heart not having suffi- 
cient power to propel the blood to the brain and other parts, consciousness is 
lost, and voluntary motion and the production of animal heat fail. Death 
would now soon occur, from the heart ceasing to pulsate, and from the blood 
coagulating in the veins ; but the body falls, or is laid down, and then the blood 
contained in the veins of the lower part of the body is poured into the heart, 
and again it excites to contraction. Thus the whole circulation is restored, and 
the brain and every part of the body receiving a fresh supply of blood, resume 
their proper functions ; but to no one of these parts is due the least credit for 
having restored the movements of the heart. When blood is withdrawn from 
the lower part of the body, the chances of recovery are much lessened ; for what 
was in the former case a reservoir, now becomes a running cistern. The recum- 
bent position is here equally valuable, since it leads to a distribution of blood 
through the vessels above the heart. It might be even an advantage to put the 
head, in these cases, slightly lower than the trunk, until the cause of the 
hemorrhage was removed. But, in general, the recumbent position is all that 
is required. The manner in which the killing of calves is performed in 
slaughter-houses, was adduced by Mr. Richardson as an instance of the effects 
produced by position on the loss of blood. He next proceeded to speak of syn- 
cope dependent on an over-burdened condition of the heart, or on debility of the 
cardiac walls. In these cases, the recumbent position enables the blood to 
pass more readily into the pulmonary artery and aorta, while the venous circu- 
lation generally is rendered more equable. Mr. Richardson then referred to 
several experiments which proved to demonstration the truth of his theory. 
Having slowly narcotized a kitten, he laid bare the heart by a careful dissec- 
tion, without opening the right pleural cavity; he then punctured the arteria 
innominata, while the animal was suspended by the head. The heart con- 
tinued contracting for some minutes, but at last the right auricle collapsed, and 
pulsation ceased. At this moment the body of the animal was reversed, and 
suspended by the heels. The auricle instantly refilled from the inferior cava, 
and the heart resumed its contractions. This was repeated with the same re- 
sults. On another occasion, the vena cava inferior was tied previous to the 
reversion of the body, when no reaction took place until the ligature was 
removed. In a third experiment, the animal was suspended, in the first place, 
by the heels, and, the abdominal aorta being punctured in the middle, the 
auricle was allowed to collapse as before ; the animal was then turned head 
upwards, when the auricle filled from the superior venous trunks. There could 
be no doubt as to the results of these experiments. — 2Icd. Times and Gaz. 
April 22, 1854. 



MATERIA MEDICA AND PHARMACY. 

13. Local Ancesthesia. — The production of local anaesthesia in disease by the 
direct application of the vapour of chloroform, was first brought into notice by 
Dr. Hardy, of Dublin, and has lately excited much attention. [Dublin Quart. 



216 



Progress of the Medical Sciences. 



[July 



Journ. Nov. The instrument, which he invented for the purpose, con- 

sists of a small metallic cylinder holding a sponge ; a pipe is fixed at one end, 
and to the other end a gum elastic bottle is attached, provided with a valve for 
the admission of air. When the sponge is moistened with chloroform, pressure 
on the elastic bottle forces the vapour through the pipe, and the jet of vapour 
can be applied directly to the affected part. The first effect produced by the 
application of the vapour is a sensation of heat, which may even cause uneasi- 
ness ; but this is quickly succeeded by the subsidence and complete removal of 
pain. The relief is said to be as speedy and perfect as it could be by inhala- 
tion, and is so permanent that the pain does not return again for several hours, 
and then only in a mitigated degree ; and there are no unpleasant subsequent 
effects, such as occur after inhalation, or after the use of narcotics. Dr. Hardy 
relates several cases, mostly of uterine disease, and generally of a very painful 
and distressing kind, in all of which immediate and complete relief was afforded 
by the angesthetic douche. His first case was one of cancer of the uterus, 
where the excessive suffering was completely removed in a few minutes by the 
chloroform vapour; and, when the pain afterwards returned, the same means 
were always resorted to, with a like effect. In his second, third, fourth, and 
fifth cases, which were examples of uterine disorders, attended by great pain 
of the back and womb, the douche applied to the uterus caused the cessation 
of the pain, first in the back, and afterwards in the womb. In a case of great 
irritability of the nipples, in various other forms of local irritation, and parti- 
cularly in a case of pruritus pudendi, the anesthetic application was equally 
successful. From this experience of its action. Dr. Hardy considered the local 
application of chloroform to be preferable to its inhalation. 

Thus strongly recommended, the practice was repeated lately in Paris pretty 
extensively, but, unfortunately, the same success has not attended it. At first, 
indeed, M. Nelaton, after applying the douche, incised an abscess on the foot 
without the patient showing any symptoms of pain ; and M. Dubois produced 
insensibility in a painful abscess of the axilla and wound of the back of the 
hand. But, with these and a few other exceptions, the douche has generally 
failed to produce anaesthesia in surgical operations. Yelpeau used it, without 
success, in a case of abscess and of cancer ; Giraldes and Nelaton, in subsequent 
trials; Gosselin and Ricord found no effect produced by it ; and Roger found 
it completely ineffectual in producing angesthesia on the sound skin. Laugier, 
however, states that he has found this method of service; and, in a case of 
painful stump, after amputation of the thigh under M. Larrey, the patient felt 
great relief from his sufferings after the chloroform application. With the 
view of increasing the effect, several modifications of the original apparatus 
have been devised. M. Richard used a much larger reservoir of chloroform, 
and expelled the vapour by means of bellows. In a case of fistula in ano, in 
which he employed this apparatus, however, no other effect was produced ex- 
cept a sensation of cold ; the incisions were as painful as they generally are. 
M. Maisonneuve having to perform amputation of the toe, enveloped the foot 
in an India-rubber bag, in which chloroform was poured, so as to keep the part 
in an angesthetic vapour bath ; but, instead of insensibility, a painful feeling of 
burning, and so much local hypersesthesia were produced, that the operation 
had to be put off till next day. In short, the method has so completely disap- 
pointed expectation, that the surgeons have latterly entirely abandoned it. 
M. Yelpeau, indeed, thinks that ether and chloroform cannot produce anaesthe- 
sia unless they are absorbed by the lungs ; and he looks upon Dr. Hardy's cases 
as not at all conclusive, in consequence of the irregular duration of uterine 
pains, and their frequent spontaneous disappearance. Yet, even in uterine 
cases, M. Dubois has renounced its use as quite ineffectual. In consequence 
of the failure of Dr. Hardy's plan, attention is now being directed to other local 
ana3sthetics. A^'elpeau still uses in many cases the production of cold by a 
freezing mixture of ice and common salt ; and the cold produced by the vola- 
tilization of ether and chloroform has lately been tried, as likely to be more 
efficacious than the douche. M. Ricket has employed this local anaesthesia by 
refrigeration in two cases, with partial success. The chloroform or ether was 
dropped upon the part, and its volatilization hastened by a current of air from 



1854.] 



Materia Medica and Pharmacy. 



217 



a ventilating apparatus which M. Mathieu has invented. The incisions which 
were made in the part caused so little pain, that there could be no doubt that 
the sensibility was deadened by this means.' 

[However deficient in success hitherto, local anaesthesia is of such great prac- 
tical importance, that it well deserves to be investigated and carried out, with 
all the appliances and resources of modern ingenuity. We understand that 
Professors Syme and Simpson have made trial of the anesthetic douche in cases 
of abscess, but although a slight and superficial impairment of the sensibility 
was noticed, no diminution of the feeling of pain took place. Dr. James Ar- 
nott's plan, of freezing the skin and subjacent parts, seems to us well adapted 
for minor operations in surgery, and we feel surprise that it has not been more 
extensively tried in this country. M. Velpeau has pronounced strongly in its 
favour. M. Richat has published some cases of operations performed without 
pain, by means of an ingenious apparatus, constructed by M. Mathieu (figured 
Gaz. des Hop. April 1). By this instrument, a fair amount of ether and of air 
is simultaneously directed to the part. Dr. Liegard (de Caen) has pointed out 
that the peasants in Lower Normandy have long been in the habit of prevent- 
ing pain by squeezing strongly the forearm or leg, when operations are per- 
formed on the hands or feet.] — Monthly Journ. Med. Sci. May, 1854. 

14. Production of Local Ancesthesia. — Dr. Snow in a paper read before the 
Physiological Section of the Medical Society of London (April 10, 1854), said 
that when a piece of folded lint moistened with chloroform was applied to the 
skin, and covered with some impermeable substance, it caused a sensation like 
that occasioned by a mustai;d poultice, and the skin became red. After the 
lapse of a few minutes to half an hour, there was a feeling of numbness in the 
part, and its sensibility was diminished, so that pricking with a needle did not 
cause so much pain as usual. He had never succeeded, however, in causing 
complete anaesthesia by chloroform applied to the sound skin, nor had he been 
more successful with several other agents he had tried. Hydrocyanic acid of 5 per 
cent,, and a strong solution of cyanide of potassium in water, caused a diminu- 
tion of sensibility, with less irritation, than any of the other medicines. The 
difficulty of causing local anaesthesia depended on the slow and sparing manner 
in which fluids permeated the cuticle, and the readiness with which the small 
quantity which did permeate was carried away in the blood. When the skin 
was denuded of cuticle, it was readily made insensible, even by the vapour of 
chloroform confined over it, and the raw surface could be rubbed without causing 
any sensation. The only means they as yet possessed of producing complete 
local anaesthesia was that of refrigeration, proposed by Dr. James Arnott. 
When a part was cooled by the application of a mixture of pounded ice and 
salt, it became of the colour of parchment, as hard as suet, and perfectly in- 
sensible. The insensibility, however, extended to only a very slight depth. 
He had congealed in this manner part of the palmar surface of the hand and 
fingers, but, on separating the latter, and examining the dorsal surface of the 
web which connects them, he found it quite sensible to the pricks of a needle^ 
even when removed from the hard and insensible palmar surface by a thick- 
ness of only the tenth of an inch. The burning kind of pain caused by the 
application of ice and salt to a sensitive part, such as the hand or fingers, was 
very considerable, and it was still greater about five minutes afterwards, when 
sensii)iiity returned. In fact, if he (Dr. Snow) required the application for 
any other purpose than to watch its efi'ects, he would inhale chloroform while 
it was done. He therefore did not think this process very available, even for 
superficial operations, except when the surgeon or the patient had an objec- 
tion to the inhalation of chloroform. A new plan had lately been tried in the 
hospitals of Paris, with some amount of success, in preventing the pain of minor 
operations by refrigeration. It consisted in dropping ether on the part, and 
increasing the evaporation with the bellows. He (Dr. Snow) had tried thi& 
on a patient of Mr. Ure, in St. Mary^s Hospital, preparatory to his dividing 
the callous edges of an ulcer of the leg. It was quite successful at that edg©- 



^ Gaz. de Hopitaux. 



218 



Progress of the Medical Sciences. 



[July 



of the ulcer where the ether had chiefly fallen, but less so at the other side. 
This process caused less pain than the application of ice and salt; and M. 
Matthieu, an instrument maker of Paris, had contrived a means by which it 
could be more effectually applied than in the above case. — Med. Times and 
Gaz. April 22, 1854. 

15. Modes of Exhibiting Cod-liver Oil. — 'Those who have had large experience 
of the use of cod-liver oil must have been astonished at the surprising way in 
which, in a great majority of cases requiring its exhibition, it agrees. It is not 
easy to mark out beforehand any class of symptoms which contra-indicate its 
employment, if the existence of strumous disease call for it. Often symptoms, 
apparently the most likely to be aggravated, are removed or mitigated by its use 
in a way which surprises both patient and prescriber. Thus, in phthisical cases, 
a red tongue, acid eructations, biliousness, heartburn, liability to sick headaches, 
aching pain between the scapulse, an instinctive and intense dislike to fat or 
greasy aliment, are symptoms which, without a question, may often be reme- 
died by the use of cod-liver oil. These statements are, of course, applicable 
only to a certain proportion of cases ; there are others in which its use is clearly 
indicated, but in which the prescriber's ingenuity is taxed to the utmost to get 
the patient to bear the remedy. The following memoranda on this part of the 
subject, founded on our observations of the practice of the various London hos- 
pitals, but more especially of the City Hospital for Diseases of the Chest, may 
probably be acceptable to some of our readers. 

Cases in which difficulty occurs may be divided into the following classes: 
1. Those in which the nauseous taste of the oil forms the obstacle. In these, the 
use of the pale oil will generally obviate the difficulty; it is, however, four times 
the expense of the brown, and is more liable to be adulterated, which are great 
objections. The taste of the brown oil may often be concealed by taking it 
floating on some bitter menstruum. A wineglassful of strong coffee, of ginger 
wine, of infusion of quassia, or, perhaps, best of all, a quinia draught, con- 
taining a drachm of the tincture of orange-peel, may serve this purpose. The 
oil may be stirred up in a little hot milk, and swallowed so warm that the sensa- 
tion of heat overpowers the taste. Should these expedients fail, the patient may 
be instructed to put into the mouth a teaspoonful of marmalade or of black cur- 
rant preserve ; and, having well lubricated all parts with the sweetmeat, so as 
to fully absorb the attention of the gustatory nerve, then swallow the oil. Ad- 
vantage frequently results from closing the nostrils when taking the dose. 2. 
Those ill which the oil excites sickness, and is quickly rejected by vomiting. Many 
of the expedients mentioned above will obviate also this source of difficulty, more 
especially the use of bitters. Yery few cases, indeed, will resist the influence 
of hydrocyanic acid and bismuth exhibited three times daily for a few days 
preparatory to the trial of the oil, and continued during its employment. Pa- 
tients should be directed to eat a little dry biscuit or bread-crust before the oil, 
and then to take it floating on a cup of the coldest spring water. If these fail, as 
a last resource, the dose should be given in the recumbent posture, that is, in 
the morning, an hour or two before getting up, and in the evening, after going 
to bed. This last suggestion is one emanating, we believe, from Dr. Birkett, of 
the City Chest Hospital, and often answers very satisfactorily. 3. Cases in 
which the oil cannot be digested. This is a large and very important class. 
Patients complain that they have a great repugnance to the oil, that it makes 
them feel sick for hours afterwards, though seldom causing actual vomiting ; 
that everything they take after it seems to taste of it, and that thus all relish 
for food is destroyed ; that the oil " rises,'' either oily or with a most nauseous 
acid flavour. They frequently have bilious attacks ; and, for a day or two in 
each week, probably the repugnance to the remedy is so great that they are 
quite unable to overcome it. If pushed under these circumstances, the oil does 
more harm than good ; there are, however, extremely few such cases in which 
careful attention to the digestive organs will not enable its administration to be 
successfully conducted. 

We copy the following formula from the Pharmacopoeia of the City Hospital 



1854.] 



Materia Medica and Fharmacy. 



219 



for Diseases of the Chest, where it is in general use for the relief of the con- 
dition alluded to: — 

"R. Had. rhei ^iij ; rad. zingiberis ^ij ; rad. gentian. 5iss; sod. carbon, 
^iij ; aquee pur. ibviij.'^ 

The roots having been cut into small pieces, the infusion is made with cold 
water, and, after standing in a cool place for about twelve hours, is strained. 
The mixture is clear and bright, and not in the least disagreeable to take. In 
cold weather it keeps well; but in summer the addition of some tincture is 
necessary to prevent it from becoming thick. If cough be present, it is usual 
to combine with each dose from half a drachm to a drachm of paregoric ; if 
sickness, from two to three minims of the hydrocyanic acid ; and if the signs 
of atony, a small quantity of the tincture of gentian, calumba, or hop. 

By the use of this mild stomachic (a wineglassful thrice daily), for a week or 
two before commencing the oil, and then continuing it during the exhibition of 
the latter, many patients have been induced to bear it with advantage, who had 
failed in other prior attempts to do so. The mixture is so mildly aperient that 
it almost never purges, and it may be continued for months together with the 
ejffect of improving most markedly both the appetite and the digestion. 4. Cases 
ill which the oil, altliough taken easily, cannot he home in full quantity, and does 
not appear to produce much henefit. In many cases of phthisis coming under 
this head, the combination of tonic medication with the use of the oil often 
answers well. So generally, in fact, is advantage derived from such combina- 
tion, that at the Hospital for Chest Diseases there are very few patients, indeed, 
who take the oil alone. In almost all it is exhibited together with either the 
stomachic mixture above noticed, or some form of tonic. The favourite tonics 
are the sulphates of quinia and iron (gr.j with gr.ij ter die), or the sesquichlo- 
ride of iron. The latter is extensively prescribed with the mineral acids in 
infusion of quassia ; or, if the stomach be delicate, in the following more 
elegant form, which is a prescription of Dr. Eisdon Bennett's: B. Tinct. ferri 
sesquichl. li\,x ; acid, nitrici dil. Tibx; syr. zingib. ^ss ; aq. menthge viridis 
Ft. haust. 

Notice has been made repeatedly in our hospital records during the last tw© 
years of the practice of combining the use of cod-liver oil with that of mercury, 
in small doses long continued, which prevails extensively at the Hospital for 
Skin Diseases, in cases of lupus and cutaneous struma, and at several other 
institutions, in the treatment of chronic disease of the joints. This kind of 
treatment is becoming increasingly prevalent, and is certainly very applicable 
to many forms of strumous inflammation. The plan of giving the oil to coun- 
teract the depressing effects of a mercurial course for the cure of syphilis in 
cachectic states of the constitution, has also been previously mentioned, and is 
well worthy of being borne in mind. — Med. Times and Gaz. May 13, 1854. 

16. Medicincd Constituents of the Lemon. — Dr. Cogswell read before the Phy- 
siological Society (March 13, 1854), a paper on this subject. The author's 
attention had been drawn to the subject by the publications of Dr. Owen Rees 
and others, on the treatment of rheumatism by lemon-juice. The remedy was 
no doubt often successful, but still there were many failures, and these did not 
seem to be sufSciently accounted for, as had been attempted, by reference to 
the different forms of the disease. But there was much uncertainty as to what 
constitutes lemon-juice. Has it always the same composition, or are there not 
various accidental circumstances attending its preparation calculated to render 
one specimen different from another. Sometimes the fruit is ordered to be 
squeezed at home; at other times, the prescription is sent to a druggist, or the 
juice is allowed to be purchased where it is cheapest. When obtained from the 
fresh fruit, by depression without removing the rind, it is a turbid, pale yellow 
fluid, exhaling a grateful odour of the essential oil, and of a specific gravity in 
different specimens between 1043 and 1047. By distilling a fresh specimen 
which had not been filtered, the author had obtained half a drachm of essential 
oil from 12 ounces; but from another, after filtering, only five minims. Some 
purchased at a fruit-preserver's, which had stood for several months in a cask, 
and undergone a kind of fermentation, was bright yellow and clear, of density 



220 



Progress of the Medical Sciences. 



[July 



1037, and yielded scarcely a trace of oil. It had received an impregnation of 
common salt from the former contents of the cask. A sample of lime-juice 
procured from the stores of a merchant-vessel, smelt of rum, had a density of 
1010, and contained a multitude of torulge. The effect of the different processes 
.for preserving the juice mentioned by Christison, was to separate one or more 
of the ingredients which might be of consequence to its remedial efficacy. 
Heat would expel the essential oil, filtration remove the solid debris of the 
pulp, and the addition of alcohol with filtration withdraw the mucilaginous 
matter. It appeared that the druggists in London do not make a practice of 
keeping the juice ready on demand, but that they generally prepare it extem- 
poraneously when ordered. The dose was equally a matter of uncertainty ; 
for although it seemed to be the prevalent idea, that the average produce of a 
lemon was about half an ounce, the author had not found any ordinary speci- 
men yield less than seven drachms, while the average was rather more than an 
ounce. Hence, he concluded that it was necessary to fix a standard for the 
composition and dose of the juice before its remedial efficacy could be fairly 
tested. In the rind, besides the essential oil, the author observed granules of 
starch. A decoction of the white spongy portion, afforded pectine, hesperidine, 
and a trace of tannin. Hesperidine was discovered by M. Lebreton, who em- 
ployed orangettes ; but his process was- complicated and unproductive. The 
author had found it was deposited in crystals by evaporating a decoction of the 
white portion of the rind, while in the same portion of the shaddock, it was 
separated by simple maceration in cold water, and could be collected in a filter. 
A specimen as thus obtained was exhibited to the Society. It had a decidedly 
bitter taste, but turned, not red as commonly stated, but yellow with sulphuric 
acid. Another principle, called aurantiin, was supposed to be the source of 
the bitterness of the lemon tribe; but its existence had not been demonstrated, 
and the author was disposed to regard the hesperidine as the true bitter prin- 
ciple. The essential oil belonged to a class corresponding to the formula C5H4, 
and including the other oils of the fruits of the lemon tribe, the oils of turpen- 
tine, juniper, savine, elemi, copaiba, cubebs, and pepper. Some of these were 
approved remedies in rheumatism. From trials made with the oil of lemon in 
this disease, in flatulent dyspepsia and leucorrhoea, the author entertained a 
high opinion of its therapeutical value, and thought that the chemical fact 
stated suggested the possibility of bringing together the various scattered evi- 
dences on the medicinal eff'ects of the oils of the same class, and referring 
them to a general law. The fresh juice, when evaporated in a water bath, 
yielded about 8.5 grains per cent, of solid extract, and the ash obtained by in- 
cineration amounted to 0.27 per cent. The latter> contained sulphuric and 
phosphoric acids, potash, lime, magnesia, and iron. A controversy existed as 
to whether the citric acid or the potash in lemon-juice was the true medicinal 
constituent. In reviewing the evidence, the author conceived that it was au 
error to suppose that either of them would answer so well separately. The 
efficiency of the juice probably depended, not on one or other of the ingre- 
dients, but on the whole combined. In using the essential oil, he gave it in 
doses of about fifteen minims, with two drachms of vinegar in decoction of 
barley, always being careful to keep the bowels freely open by purgatives. If 
the efficacy of lemon-juice in acute rheumatism depended on anything more 
than the refrigerant action of the citric acid, he thought the true anti-arthritic 
agent was the essential oil when present, and repeated his views as to the 
necessity of establishing a standard for the composition of the juice. A Table 
was exhibited, showing the correspondence in composition of the non-oxygen- 
ated essential oils mentioned in the paper. 

Dr. Routh differed from the author as to the chemical elements in the lemon, 
to which the medicinal virtues might be attributed; the author attributing them 
to the essential oil, while Dr. Routh and Dr. Garrod believed them to be due to 
the potash. Acting on this principle, he was accustomed to give half to two 
drachm doses of potass, and thus add to the effect which would be obtained 
from lemon-juice. Dr. Garrod had not observed disease of the heart to follow 
rheumatism when treated in this way ; and, moreover, he cured his cases within 
one week. The theory of the action of the potass, is simply that of neutralizing 



1854.] 



Medical Pathology and Therapeutics. 



221 



the lithic acid, but its action is far more effectual if lithic or tartaric acids be 
united to the base. Oil of juniper, acting as a diuretic, had also in his prac- 
tice effected the cure of rheumatism and gout within a week. 

Dr. Glover referred to two classes of diuretics. The one by which the quan- 
tity of water is alone increased, as by the action of the oil of juniper; and the 
other, by which the solid constituents of the urine are increased in quantity, 
as by the action of acetate of potass. He was not disposed to admit that great 
simplicity in the exhibition of remedies is necessarily the best mode of pro- 
cedure, and instanced the meconite of morphia qis a better medicine than mor- 
phia or opium simply. 

Mr. Headland criticized the author's statements somewhat severely, and was 
of opinion that the paper had proved nothing, and that the analyses were 
rather empirical than scientific. He doubted if the medicinal virtues of the 
lemon-juice could be attributed either to the essential oil or to the potass, 
for the small quantity of oil would be dissipated by boiling; and sailors who 
eat salt-beef, containing much potass, are subject to scurvy, and are cured by 
the administration of lemon-juice. Moreover, Dr. Bryson had remarked, that 
while the administration of nitrate of potass alone had benefited but one case 
in five ships'-crews, all the others were cured by lemon-juice. Fresh vegetables 
in general are sufficient to cure scurvy without Dr. Garrod's remedy of nitrate 
of potass ; and it is very questionable if the disease can be cured apart from 
the use of vegetables. Upon the whole, he could attribute the good effects ac- 
cruing from the use of lemon-juice to the combined citric acid and salts of 
potass. — Med. Times and Gaz. April 1, 1854. 



MEDICAL PATHOLOGY AND THERAPEUTICS, AND PRACTICAL 

MEDICINE. 

17. Pyrosis, its Causes, Pathology, and Treatment. — Dr. George Budd, in an 
interesting lecture {Med. Times and Gaz. March 18, 1854) on Pyrosis, observes 
it is most probable that the disorder in countries in which it is endemic, is 
mainly owing to the influence of climate and to the diet of the poor not being 
sufficiently varied, and consisting too much of coarse and innutritious farina- 
ceous food. 

But if such be the main causes of the disorder, there are, doubtless, various 
other conditions that assist in bringing it on. Most of these may be classed 
under two heads: — 

\. Excessive labour, insufficient clothing, loss of blood, and all, other condi- 
tions that tend to exhaust the body. 

2. Pregnancy, constipation, anxiety, and other conditions that tend to dis- 
order the functions of the stomach. 

We have already seen that waterbrash occasionally occurs in a high degree 
in the wealthy classes, especially in women, where it cannot be ascribed to anj 
peculiarity in diet, and seems to be owing solely to such conditions as these. 

Pyrosis, then, considered with reference to its exciting causes, is of two 
kinds: — 

1. That which has been termed by some writers symptomatic pyrosis, which 
is brought on (without any peculiarity in diet) by pregnancy or some other 
condition that disturbs the functions of the stomach. 

2. That which has been termed, in contradistinction to the former, idiopathic 
pyrosis, which prevails chiefly among the agricultural poor in rural districts, 
and which seems, in most cases, to be mainly owing to defective diet. 

Many conditions conspire to render the disorder much more frequent in 
women than in men. Women are much more frequently in states of debility 
from the nature of their constitutions, and from their having in suckling and in 
excessive or unnatural uterine discharges, causes of exhaustion from which 
men are exempt; thev have also more excitable nervous systems, and, in con- 
No. LV.— July 1854, 15 



222 



Progress of the Medical Sciences. 



[July 



sequence, the functions of the stomach in them are more apt to be deranged by 
mental influences and by disease in other parts of the body; and among the 
lower classes, they have generally a less nutritious diet, since the men, in order 
to support their more laborious work, take or have accorded to them a larger 
quantity of animal food and of malt liquors than is consumed by the weaker- 
sex. 

In the treatment of waterbrash, our first endeavour should, of course, be to 
remove the conditions that may seem to have brought it on or to maintain it. 

If the disorder should seem to be caused mainly by a diet not sufficiently 
nutritious or consisting too much of farinaceous substances, the most eJffectual 
remedy will be a wholesome nourishing diet, containing a proper quantity of 
animal food in its most digestible form. Little permanent benefit can, indeed, 
be expected from medicine unless the diet is improved. 

If the disorder should seem to have been induced, or to be kept up, wholly 
or in part, by fatigue, it is very essential that the patient should rest; if by con- 
stipation, that this condition should be removed by purgatives, such as aloes 
or colocynth, that do not ofi"end the stomach. 

After these points have been attended to, much further good may be done by 
medicines. 

The medicines that have been found most useful in pyrosis are — 

1. Medicines which have an astringent action on the coats of the stomach. 
Among these may be classed bismuth, lime-water, and the vegetable astrin- 
gents — kino, catechu, krameria, logwood. 

2. Sedatives, especially opium and the salts of morphia, which probably also 
tend to restrain undue secretion by the mucous membrane, but which are chiefly 
of use in allaying the gastralgia that attends pyrosis. 

Medicines from these two classes may often be combined with advantage. 
Five grains of bismuth with a twelfth of a grain of the muriate of morphia, 
or five grains of the compound kino powder, or an efficient dose of catechu, 
krameria, or logwood, with opium, may be given two or three times a day. 

3. Some other medicines have obtained repute in pyrosis which cannot be 
classed with the preceding. They have most of them an astringent action on 
the coats of the stomach, but act, directly or indirectly, on the nervous system 
as well. 

The chief of these are, nitrate of silver, which may be given in pills, in doses, 
of half a grain, three times a day; nux vomica, which may also be given in 
pill, in the dose of from three to five grains, three times a day; quinia;. and 
the mineral acids. 

Some of the medicines I have mentioned have been popular remedies for py- 
rosis in districts in which the malady has prevailed. 

It is stated that nus vomica is a popular remedy among the Laplanders, to 
'whom it was recommended by Linnasus, and that lime-water was some years 
ago a popular remedy among the rural population of North Wales. 

4. The disorder is often connected with ansemia; and steel is of great service, 
both in removing it and in preventing its recurrence. 

The medicines of which I have had most experience in disorders of this class, 
and which are probably as efficacious as any, are bismuth, with morphia; kra- 
meria, and logwood, with opium; and steel. 

18. Treatment of Diabetes. — Several cases of diabetes have recently occurred 
in the hospitals, in which the treatment so much vaunted two years ago by 
.the permanganate of potash, has been tried fairly, without any good result. 
The theory which refers the original lesion to the nervous system, and con- 
siders the defective assimilation as a mere symptom, appears to gain ground 
among London physicians. Dr. Goolden, of St. Thomas's Hospital, related, in 
some clinical remarks, a few weeks ago, the case of a guard of a railway train, 
who received a severe blow on the head; and, while suffering from the conse- 
quent cerebral symptoms, passed large quantities of sugar in his urine. 
Guided by this fact, as well as by the well-known experiments on animals, in 
which saccharine urine may be produced by irritation to the floor of the fourth 
ventricle, Dr. Goolden has directed his measures of treatment to the head. 



1854.] 



Medical Pathology and Therapeutics. 



223 



Four cases have been or are under treatment in St. Thomas's, and in two, 
very great benefit appears to have been derived ; the patients, meanwhile, not 
being restricted in any way as to the use of vegetable diet. Shaving the 
scalp, blisters to the nape or scalp, and small, repeated doses of mercury have 
been the chief measures adopted. 

19. Tojjical Uses of Iodine. — The value of iodine as a counter-irritant is year 
by year becoming more generally appreciated, and is yet much less so than it 
deserves. The iodine solution will probably, before long, entirely supersede 
mustard plasters, being at once more efi&cient, and much less disagreeable in 
its employment. The following notes on its applications will, perhaps, not be 
useless ; they are the results of very extended observations in the hospitals 
generally, but more especially in those devoted to the treatment of diseases of 
the chest — 1st. In the pleuritic stitches, or aching pains in the chest, so com- 
monly recurrent in the course of phthisis, the iodine paint,' applied over the 
affected spot, usually affords, without any expense to the vital powers, much 
more relief than either leeches, sinapisms, or blisters. It may be used in 
almost all conditions of the system w^ith perfect safety. 2d. In cases of apho- 
nia or hoarseness, depending on inflammatory thickening of the parts con- 
cerned in the production of voice, great benefit may be derived from painting 
the iodine over the front of the throat externally. 3d. If the mucous lining of 
the fauces, etc., be thickened and congested, the solution may, without risk, 
be freely applied to the part itself. 4th. In the treatment of chronic enlarge- 
ment of the tonsil, the application of iodine to the gland itself will sometimes 
effect a cure, but is much les« generally ef&cient than constitutional treatment. 
6th. In cases of chronic pleuritic efl'usion, or of consolidation of the lung, the 
solution should be painted over a large extent of the diseased side, and is of 
great service when the period for blistering or leeching has passed. 6th. Ap- 
plied extensively over the belly, iodine is a useful counter-irritant in the inci- 
pient stages of strumous peritonitis. 7th. In strumous ophthalmia, the appli- 
cation of the pharmacopoeial tincture to the skin of the lids is often effectual 
in relieving intolerance of light; much benefit may also be derived from like 
practice in cases of granular lids. In both instances, frequent repetition is 
necessary. 8th. In all forms of periostitis, whether syphilitic, strumous, or 
the result of injury, iodine paint is invaluable. 9th. It is needless, perhaps, 
to mention the employment of iodine as a local application to bronchocele, to 
inflamed joints, and to enlargements of the absorbent glands ; with regard to 
the latter, a point is worthy of being borne in mind, to which Dr. Budd was, 
we believe, the first to direct attention, viz., the propriety of applying it to the 
skin beyond, and not over the affected gland, so as to allow of its being ab- 
sorbed and taken through the gland in the course of the lymphatic circulation. 
10th. Injections of iodine into the cavities of abscesses, glandular or otherwise, 
appear most frequently to produce good results, and to be unattended, except 
in very exceptional instances, by any risk. The theory of their use is, that 
they provoke adhesive and not suppurative inflammations, as, for instance, in 
the radical cure of hydrocele. 11th. In cases of contracted cicatrices after 
burns, in which treatment by extension is adopted, the application of iodine is 
of advantage in causing the absorption or softening down of the indurated 
structure. Some cases illustrative of this have recently been under care in the 
Middlesex Hospital. Care must be exercised, or ulceration may be caused. 
12th. In cases in which the patient cannot be got to swallow medicine, as now 
and then happens in phagedssna of the throat, the specific influence of iodine 
may be induced by its endermic application, the best method being to paint 
over large surfaces of skin the pharmacopoeical tincture, choosing a different 
part each time. 

1 The following is the formula for the solution alluded to : — R lodinii ^\ ; sp. vini 
rectificati gi ; Ft. solutio. This should be allowed to stand by in a glass-stoppered 
bottle for some months before required for use. It then becomes thick and syrupy, 
rapidly dries when appUed to the skin, and does not run. It should be applied with 
a camel-hair brush, oue, two, three, or more coatings, according to the wished-for 
effect. 



224 



Progress of tlie Medical Sciences. 



[July 



The reason why, as a counter-irritant in all forms of chronic inflammation, 
iodine appears so superior to other applications, is doubtless to be found in the 
fact that it is capable of absorption, and may thus act beneficially in two dis- 
tinct methods. 

We have enumerated above some of the chief uses to which the iodine solu- 
tion is daily put in the practice of the London Hospitals, but do not profess to 
have mentioned all. These are, however, enough, we think, to prove its right 
to a place on the dispensing table of every Medical practitioner. — Med. Times 
and Gaz. April 8, 1854. 

20. Abortive Treatment of Smallpox hy Zinc Plaster. — Dr. John Hughes 
Bennett remarks that the efficacy of the mercurial plaster in preventing pitting 
in cases of smallpox is well established ; but excessive and dangerous saliva- 
tion has been occasioned by it ; and he asks Avhether the mercury is necessary 
for the success of the treatment. " Its original propounders in Paris," he re- 
marks, " may, indeed, have supposed that the absorbent powers of the drug 
was the true cause of its success, but it seems to me that another explanation 
may be offered. There is, for instance, a close analogy between the mode of 
healing of wounds and ulcers, so well described by Dr. Macartney of Dublin — 
that is, the so called ' modelling process' — and what takes place in the ectrotic 
treatment of smallpox. In the former, cicatrices are far less liable to be pro- 
duced than after healing by the first or second intention ; and in the latter, the 
pitting or cicatrization is prevented. The artificial plaster, therefore, takes the 
place of the natural scab or clot of blood, protects the parts below, and enables 
them to heal slowly but more perfectly than if exposed to the air uncovered 
and uncompressed by superjacent crusts. If this be the correct theory of the 
ectrotic treatment, the mercurial might be discarded, and any kind of plaster 
which would concrete on the face, might be expected to produce the same bene- 
ficial result. This session, I determined to try the efi"ects of s'lch a plaster, and 
after two or three failures have succeeded in procuring one that answers per- 
fectly. The first case I treated with simple lard, thickened with starch and 
powdered charcoal, but it was so little coherent, that the patient, during the 
night, rubbed it off on her pillow or with her hands, and on her recovery she 
was pitted all over. In another case I tried carbonate of magnesia saturated 
with oil. But this also failed. In a third case, however, common calamine 
[zinci carbonas), saturated with olive oil (proposed by Mr. Bird, one of the 
clinical clerks), formed a coherent, tough crust, which remained on the face, 
and was found to answer well. Three cases of natural smallpox have been 
since treated in this manner with the result, not only of preventing the pitting, 
but of diminishing the local and general symptoms, exactly' in the same manner 
as I have formerly detailed, as being the effect of the mercurial plaster. The 
following is one of these cases: — 

*' Alexander Ross, a3t. 13, never been vaccinated, was seized with shivering on 
the 7th January, followed by the usual symptoms of fever. Entered the In- 
firmary on the 9th, when a few papules were observed on the face and arms. 
On the 12th, the face was thickly covered with vesicles, which from their close- 
ness would certainly have become confluent. The mask of calamine and oil 
was now applied. The disease ran its usual course, the eruption being con- 
fluent on the arms and trunk. Throughout the progress of the case, the appli- 
cation of calamine saturated with oil preserved a firm and coherent crust, and 
was renewed from time to time. The patient experienced no smarting of the 
face, there was no swelling of the eyelids, no purulent discharge, or local un- 
pleasant symptoms of any kind. The secondary fever was tolerably smart, 
delirium being present two days. On the 22d the mask came off, leaving a 
clean smooth surface, free from all trace of pitting. Dismissed quite well on 
the 26th. 

" The following formula, after numerous trials, has been found to constitute 
the most efficient plaster; Carbonate of zinc, 3 parts; oxide of zinc 1 part, 
rubbed in a mortar with olive oil to a proper consistence." — Monthly Journ. 
Med. Sd. April, 1854. 



1854.] 



Medical Patliohgy and Therapeutics. 



225 



21. Formula for Gouty, Rheumatic, and Neuralgic Affections. — In the Revue 
de Thirapeutique Medico- Chirurgicale for Oct. 1, 1853, we are told that Dr. 
Gaffard, of Aurillac, has endeavoured to ascertain the composition of a secret 
remedy named pills of Lartigue, which have proved very successful in the 
treatment of rheumatism, gout, and neuralgia. Dr. Gaffard has arrived at the 
following formula, which he has communicated, in order that it may be tested, 
to the Society of Medicine of Toulouse. 

R. Extract of sabadilla, prepared with boiling alcohol, gr. xvss ; Barbadoes 
aloes, and pure Aleppo scammony, of each gr. Ixxviiss. — Mix. To be divided 
into ninety-six pills. 

Two of these pills are given every six hours, until the bowels have been 
purged from four to ten times in twenty-four hours. 

To obtain a complete and lasting effect, the use of the pills must be continued 
for some time. But as their purgative effect increases in direct ratio to the 
repetition of the dose, and as it is important to regulate this effect and render 
it uniform, the intervals between the doses should increase in an arithmetical 
ratio of three hours. Thus, after having obtained the wished for effect, what- 
ever number of pills may have been taken, the dose is delayed for three hours; 
that is to say, if the interval has been six hours, it becomes nine ; if nine, it 
becomes twelve ; and so on, until twenty pills have been taken which is gene- 
rally sufficient. 

After each dose of the pills, a cup of tea should be drank ; and this should 
also form the ordinary beverage of the patient while the purgative effect con- 
tinues. There must also be an interval of at least an hour between the dose of 
pills and the hour of rest. — Assoc. Med. Jouru. Feb. 10, 1854. 

22. Cotyledon Umbilicus in Epilepsy. — W. H. Raneing, M. D., of Norwich, 
in a letter to the Med. Times and Gaz. (April 1, 1854), states that, as far as his 
own experience goes, he should pronounce the cotyledon utterly worthless 
as an anti-epileptic remedy. "I have given," he says, "Hooper's preparation, 
carefully and perseveringly, in more than thirty cases, public and private, in 
patients of all ages, and in not a single instance could I trace the smallest 
benefit to its operation. Many cases certainly were of an unmanageable cha- 
racter, and derived no benefit from any other medicine ; but I have notes of 
three or four in which a most marked improvement has followed the use of the 
oxide of zinc in increasing doses, after several weeks had been, as I consider, 
wasted in the employment of cotyledon." 

23. Oxide of Zinc and Hyoseyamus for arresting Colliquative Sweatings in 
Phthisis. — Dr. Theophilus Thompson recommends {Lectures on Phthisis) oxide 
of zinc and extract of hyoseyamus, of each four grains, made into two pills, to 
be taken at bedtime, for arresting the colliquative sweating in phthisis. 

24. On the Influence of Belladonna in Counteracting the Poisonous Effects of 
Opiiim.—Dr. Graves had first suggested that in continued fever, with pro- 
tracted pupils and coma, if an agent administered internally would occasion 
dilatation of the pupils, it might also relieve the other symptoms of cerebral 
derangement. Dr. Thos. Anderson, acting on this theory, administered large 
doses of belladonna in two cases of poisoning by opium, which he related as 
follows : — 

A patient, of whom I had charge, and labouring under delirium tremens, 
having received an overdose of a solution of the muriate of morphia, became 
comatose. He had taken, in thirty-six hours, two ounces of the solution of the 
muriate of morphia, and it had been continued by the attendant after sleep 
was procured. When I saw him he was in profound coma, his breathing was 
stertorous, amounting to no more than four or five per minute, and his pupils 
were contracted to mere points. His pulse was excessively weak, and rather 
slow ; it was quite impossible to rouse him. I ordered him immediately the 
following mixture: Tincture of belladonna six drachms, in five and a half 
ounces of water, of which an ounce was to be given every half hour. Three 
ounces of the mixture were administered with great caution^ after which his 



226 



Progress of tJie Medical Sciences. 



[July 



pupils began to dilate. The six drachms of the tincture of belladonna were 
taken, and in four and a half hours after the first dose of it was given, the 
patient was in the following condition: The coma was entirely gone, respira- 
tions were between twenty-two and twenty-five per minute, the pupils were 
much dilated, the pulse had risen to nearly one hundred and twenty in the 
minute, and was also increased in strength. His countenance, also, from being 
cold and pallid, had become much flushed, and the whole body was much 
warmer. He replied readily and coherently to all my questions. He continued 
to improve for three days after, when, rising suddenly to stool, he fainted, and 
before the assistance of the nurse could be procured, he was dead. 

A fortnight afterwards, a woman, about fifty years of age, took, at 4 o'clock 
P.M., two drachms of laudanum, and at half-past 5 P.M. three drachms more. 
She was brought to the Infirmary at 8 o'clock P. M. After making vain at- 
tempts to rouse her from the coma, by walking her about, etc., the stomach- 
pump was used at a quarter past 8 o'clock. By this means her stomach was 
thoroughly evacuated, but no trace of opium was detected by smell or sight. 
It had probably been all absorbed. A current of electricity was then applied 
to her hands for nearly ten minutes, but without rousing her. I saw her at a 
quarter to 9, P.M. for the first time, and on being told that she had been 
poisoned by laudanum, I determined to try the efiects of belladonna. 

At that time her pupils were contracted to mere points, her respiration was 
stertorous, ten per minute, the pulse was feeble, and the extremities rather 
cold. Between 9 and half-past 9, I gave her one ounce of tincture of bella- 
donna in three ounces of water, which was all swallowed, but with difiiculty. 
In the course of the next half hour two drachms more were administered. At 
II P.M. the first alteration in the size of the pupil was observed ; the respira- 
tions had also then increased to twelve or thirteen in the minute, and the pulse 
was much stronger. The symptoms continued to improve till 2 A.M., when 
all indications of opium poisoning had disappeared. The woman was then 
sitting up in bed talking to the nurses, with pupils dilated to a little more than 
their natural size, and still slightly sensible to light. The extremities were 
quite warm, the pulse was about 100, and of good strength. 

She gave me a coherent account of her motives for taking the poison, of the 
amount of money she had spent in purchasing the laudanum, and the names 
of the druggists where it had been procured. She also replied sensibly to 
questions about her family, and the age and occupations of her children. She 
continued awake till nearly 4 o'clock A. M., after which she slept till 9 A.M. 
In the morning I found her pretty well, her pupils being no more dilated than 
they were four hours after the first administration of the belladonna. She 
complained, however, of nausea, but unaccompanied with vomiting. This 
symptom, along with the dilated pupils, had entirely disappeared in the course 
of two days. She was kept in the hospital, under observation, for ten days 
after the accident, at the end of which time she was dismissed, perfectly well. 
The tincture of belladonna, used in both these cases, was of the strength of 
four ounces of the leaves to two pints of rectified spirit, and prepared by per- 
colation. Half a drachm is considered a full dose. I have seen dilatation of 
the pupil produced by a drachm given at once. 

The committee on Dr. T. Anderson's communication reported that they had 
designed to test Dr. A.'s views by experiments on animals, but had found, on 
inquiry, that the animals commonly used for experiment were almost entirely 
insusceptible of the poisonous action of opium or belladonna. Where the 
effects were so different from those observed in man, it was obviously impossi- 
ble to pursue the investigation which they had intended. The committee, 
therefore, while recognizing that Dr. A.'s views require more extended ob- 
servations in order to confirm them, deemed them worthy of the attentive con- 
sideration of the Society. — Proceedings of Physiological Society of Edinburgh, in 
Monthly Joitrn. Med. Sci. April, 1854. 

25. Local Use of Veratma, especially in Scrofulous Affections of Joints. — In the 
Glasgow Medical Journal for Jan. 1854, Dr. J. B. Klingner has published a 
paper on the local use of veratria. He considers that it is a powerful specific 



1854.] 



Medical Patliology and Therapeutics. 



227 



stimulant ; and that it is also an anodyne, different, however, from opium, 
seeing that it does not blunt the nervous sensibility, but rather excites it, 
which is known by a tingling, pricking feeling, often accompanied by slight 
shocks resembling those that are produced by electricity, and by an increase of 
temperature, yet unaccompanied by redness, which, however, does take place 
when veratria has been used for a long time, and when there is a tendency to 
active inflammation. It is inadmissible in active inflammation ; but when this 
stage has subsided, of extraordipary efficacy in chronic non-malignant swell- 
ings, especially around joints ; it is inadmissible where there is heat and red- 
ness. Where, however, the active stage has passed, it is eminently useful in 
removing residual indurations and swellings : thus, in tumefactions and stiff- 
ness of joints, often remaining after sprains, luxations, and other injuries, it is 
valuable ; as well as when synovial membranes are thickened, ulcerated, and 
a partial anchylosis is established. Indolent and scrofulous ulcers assume a 
healthy action, and cicatrize, under its use. 

The mode of application must be varied according to circumstances ; and it 
requires a great deal of perseverance, both on the part of the patient and the 
medical attendant, as also much caution and care. Dr. Klinger commonly 
uses the veratria in the form of ointment, in the proportion of five to ten grains 
to the ounce of axunge, the veratria being at first dissolved in a little spirits of 
wine or tincture of capsicum. Of this, about the size of a small bean is rubbed 
into the affected part with the bare hand, gently and steadily shampooing it 
for a quarter of an hour. Under this treatment, the swelling will decrease 
sensibly every day, the joint will assume a more healthy aspect, and become 
gradually more movable, particularly if passive motion be daily practised. 
No bandage of any kind is to be applied. If the patient be anxious to have 
the part covered, a slip of flannel may be loosely applied. Mercurial ointments 
are worse than useless: shampooing, even with simple ointment or oils, is pre- 
ferable ; and when veratria cannot be longer tolerated, on account of the itch- 
ing it produces, sometimes over the whole body, friction with glycerin is of 
immense value. Glycerin seems to be readily absorbed, and soon gives a 
more natural look to the limb, which remains moist and comfortable long after 
its use. 

Dr. Klingner finds veratria useful in cases of deposit resulting from the non- 
removal of effete matter. These deposits occur most frequently in such situa- 
tions as the knee and elbow joints. There is a feeling of coldness in those 
localities when affected by the disease, and anything that gives heat for a time 
is grateful ; yet warm applications, although of temporary relief, always tend 
to increase the disease. Cupping, leeching, blisters, etc., are often used with 
the view of causing diminution of the swelling, and, as it is said, to subdue 
inflammatory action. Dr. Klingner's opinion is, that diseases which are bene- 
fited by veratria are principally those caused by want of vigour in the whole 
system. 

"When a joint, such as the knee or elbow, is affected by scrofulous deposit 
around it, and consequent ulceration, and partial or complete anchylosis is 
established, and the whole has become a bluish-white unshapely mass of cer- 
tainly destructive disease, doughy to the feel, and of a lower temperature than 
natural, some time will elapse before the veratria seems to have any effect ; 
yet, by persevering daily with its use, and shampooing, it will gradually di- 
minsh in size, and the distended, cadaverous-looking skin will present a more 
natural appearance, and acquire a higher temperature. If the frictions with 
veratria ointment be persevered in at night, and a tincture composed of con- 
centrated tincture of capsicum, with twenty grains of veratria to the fluid 
ounce, be rubbed in the following morning, after a time redness and heat will 
take the place of the former whiteness and cold, the joint itself will become 
more movable and at the sam.e time somewhat more painful. If the disease 
do not give way by absorption of the effused matter, we must endeavour to 
induce healthy inflammation by stimulating the diseased mass, by which 
means the scrofulous deposit is transformed in great part into laudable pus. 
Such, however, can only be the case when the constitution has undergone a 
favourable change. The doughy mass becomes softer, and fluctuation is per- 



228 



Progress of the Medical Sciences. 



ceptible at different points ; but the process of absorption is very slow. The 
best plan is, to introduce an exploratory needle, or a sharp-pointed bistoury, 
into the tumour once or twice, and continue the veratria frictions. In about 
two days after this operation, the heat and redness in the part will increase, 
and a painful throbbing will be complained of by the patient, with concomi- 
tant sympathetic fever. The wound made by the needle or bistoury discharges 
for a few days merely a little hot serum, after which the swelling, as well as 
the heat and redness, rapidly increase. These symptoms ought not, however, to 
alarm the medical attendant. He ought not to apply too soon fomentations and 
poultices : the inflammation must be allowed to come to a point which insures 
success, after which poultices may be applied to moderate its violence, and 
some cooling medicine, and, if the case require it, even colchicum may be 
given. When the inflammation is subdued as far as is desirable, the poultices 
may be continued for about two days longer, and the use of the veratria 
cautiously resumed. In most cases, it will now be found necessary to give a 
free outlet to the pus ; and, when it is completely evacuated, the bottom of the 
wound is to be touched every day with lunar caustic, and dressed simply with 
dry lint; or, if very indolent, with equal parts of Venice turpentine and resin- 
ous ointment. Care ought to be taken, at the same time, not to touch the 
wound during the frictions with veratria ointment. After the contents of the 
abscess are discharged, the joint becomes more distinct, but, at the same time, 
more painful to the touch. The integuments around it, from the partial de- 
struction of the periosteum, adhere gradually to the bones themselves, which, 
however,' in course of time, are again somewhat loosened; and a loss of sub- 
stance of the bone and adjacent tissues becomes apparent, by depressions in 
the site of the evacuated abscesses. Some little deformity is generally left, and 
the motion of the joint is often somewhat impaired; yet, where the disease has 
not been allowed to proceed too far, the cure is complete. "Where, however, 
the articulating surfaces are enlarged, or complete anchylosis is established, a 
complete restoration of its mobility can never take place. After the deposit 
surrounding the joint has been either absorbed or evacuated, the remaining 
stiffness is at least to a great degree removed by steady and cautious attempts 
at flexion and extension of the limb, repeated daily, and shampooing with 
veratria ointment at first, and towards the end of the cure with glycerin. 
Besides the enlargement of the articulating surfaces, the contraction of the 
flexor muscles impedes very much the extension of the limb. As the joint in- 
creases in size, the limb above becom.es atrophied, and the whole at last be- 
comes a source of bodily and mental distress and irritation. 

" The hip-joint is also not unfrequently the seat of the disease, which here 
implicates not only the joint itself, but is apt to carry its destructive tendency 
to the whole os innominatum. In this joint, owing to its depth, veratria has 
not the same power, and cures of hip-joint disease must be more rare and diffi- 
cult than those of the more superficial joints. 

" In hydrops articuli, produced by external injuries or cold, in or appearing 
as a sequela of typhus fever, scarlatina, measles, etc., effusions from sprains, 
dislocations, and chronic inflammation of the bursEe and tendons, veratria is of 
the greatest efficacy ; but it can only be used with safety and benefit, when no 
active inflammation is present, or when the constitution is not much broken 
down by long standing local or constitutional disease. When the patient is 
affected with tubercles of the lungs and mesenteric glands, we cannot expect 
a cure ; but mere irritative fever from local disease does not warrant us in 
giving an unfavourable opinion." 

The vertebrae sometimes become affected by scrofulous disorganization ; we 
must, therefore, be careful before we give too favourable a prognosis, in cases 
where even the lungs and abdominal viscera appear to be healthy. We must 
not in all cases rely alone upon the efficacy of veratria locally applied, for the 
condition of the viscera may have had much to do in the beginning with the 
after development of the local symptoms. Dr. Klingner illustrates his observa- 
tions bv the records of five cases of diseased ioints. — Assoc. Med. Journ. Feb. 
10, 1854. 



1854.] 



Medical Pathology and Therapmtics. 



229 



26. Exercise of the Vocal Organs in Ulceration of theLarynx. — In the Journal 
de Medecine et de Chirurgie Pratiques for October, 1853, we learn that in the 
laryngeal ulceration which frequently complicates pulmonary consumption, M. 
Trousseau applies, as local remedies, solution of nitrate of silver, calomel with 
finely powdered sugar, nitrate of bismuth with sugar, arsenicated cigarettes, 
fumigations with chlorine, iodine, etc., and instead of prescribing silence, as all 
writers have done, he orders his patients to speak. He thus employs a mode 
of treatment analogous to that adopted in cases of ulceration of the leg by M. 
Boyer, and which is advocated in this country by Mr. Chapman and others. 
M. Boyer allowed his patients to walk about and follow their ordinary occupa- 
tions when their legs were bandaged ; and the result was a more rapid and 
solid cure, the cicatrix acquiring a strength which rendered subsequent lacera- 
tion of comparatively infrequent occurrence. M. Trousseau waits until the 
acute or painful stage of the disease has passed ; he then submits his patients 
to a course of gymnastic exercises of the voice and speech. He is careful not 
to make them speak in a low voice ; having learned from priests, many of 
whom lose their voice, that the confessional fatigues the larynx more than 
preaching in a large church. 

During four or five months at least, the patient reads slowly and aloud five 
or six times daily, taking care, at the end of each period, or member of a period, 
to inspire as much air as the lungs can contain. He must make deep inspira- 
tions, and then emit several sounds in succession without exhausting the pro- 
vision of air. He then inspires again, and emits fresh sounds, always avoiding 
the higher notes, which are fatiguing. If, after several months, the voice re- 
mains false or obscure, we m-ay employ a process which was the secret of a pro- 
fessor of singing named Larochette, but which M. Trousseau accidentally dis- 
covered. Larochette used to desire singers who had lost their voice, to take as 
deep an inspiration as possible, and then, suddenly and in as little time as 
possible, to emit a short shrill note, expelling all the air which they had in- 
spired. M. Trousseau has seen many persons who had lost their voice for years, 
recover it in a fortnight under this treatment. It must be remembered, how- 
ever, that vocal gymnastics have succeeded only when the ulceration of the 
larynx has been cured, and when the aphonia has been, properly speaking, only 
a want of power arising from the prolonged rest of that organ. — Assoc. Med. 
Journ. Feb. 10, 1854. 

27. Neuralgic UeadacTie. By J. Murphy, M. P. — Neuralgic headache is sy- 
nonymous with those headaches described by some old authors as hemicrania, 
by others as clavus hystericus, and by Dr. Graves as hysterical congestion. It 
\B peculiar to females, and to females during a certain period of their existence 
only, from puberty until the final cessation of the menstrual secretion. Dr. 
Graves gives a graphic description of the symptoms and of the injurious efiects 
of the usual routine treatment. He calls it hysterical congestion; but he seems 
not to have understood its true pathology. There is no doubt of its being hys- 
terical ; but there is no congestion, for the seat of the pain is in one of the 
nerves of the scalp, which can be easily proved by a slight examination, and 
it is therefore an external headache. The error may have arisen from his hav- 
ing met with cases where this headache was in combination with the ansemio 
headache. The proper name which should be bestowed on this headache, in 
order to facilitate the diagnosis, is spinal irritation of the sub-occipital nerve. 
Spinal irritation is beginning to be well understood in this country ; we are 
indebted to a French physician, M. Valleix, for the discovery. Since then 
many other disorders, such as irritable mammae, pleurodyne, and neuralgic 
headache, are discovered to originate in functional derangement of the spinal 
cord; and I believe whoever will carefully compare these disorders with cases 
related by Dr. Tilt, must come to the conclusion that they are nothing more 
than symptoms of subacute ovaritis. They are hysterial disorders, and hysteria 
is subacute ovaritis, which displays its phenomena on the sensitive and motive 
nerves of the spinal column. 

On comparing the neuralgic headache with the phenomena of spinal irrita- 
tion in other parts, we find how exactly they coincide. Like spinal irritation, 



230 



Progress of the 3Iedical Sciences. 



[July 



it is a form of hysteria, and therefore peculiar to females. It is not only peculiar 
to females, but attacks them only during the menstruating period of their exist- 
ence ; that is, from about the thirteenth to the fiftieth year. It is exacerbated 
just previous to menstruation, makes its first attack on the left side, and rarely 
passes over to the right side. 

Cause. — As this form of headache is peculiar to the female sex, it must there- 
fore have its origin in some organ peculiar to them; and as it is felt during a 
certain period of existence only, the organ must have the performance of its 
functions limited to that period. As there is no organ by vt'hich these two facts 
are explicable, unless the ovarium, it is not unphilosophical to conclude that the 
disorder proceeds from the ovarium. There is certainly also the uterus, but 
the functions of this viscus cease on the removal of the ovaria. We daily meet 
with the uterus inflamed, ulcerated from cancer or cauliflower excrescences, 
distended by hydatids or pregnancy, producing moles and polypi, but none of 
the phenomena of spinal irritation are present. In the married female, who 
bears children regularly, it is scarcely ever known. Before the commencement 
of menstruation, or after its termination, it is equally rare.' What is the state 
of the ovarium, I do not pretend to affirm. If inflammation, yet it has often 
yielded to tonics; it may depend on moral causes, but such an explanation has 
never satisfied me. An accumulation of feces in the rectum has appeared to 
me as occasionally the source of irritation ; in a few cases, I think it was trace- 
able to ascarides in the rectum. We witness the action of cold in paralyzing 
the trunk of a motor nerve, the portio dura, as it escapes from its cranial fora- 
men; but cold cannot be a cause of this headache, otherwise why should not 
the male sex equally suff"er. 

Occasionally, spinal irritation, in other parts, has been observed earlier in 
life, but I have not met with the headache; and, as the headache has occurreji 
some years before the appearance of the menses, so I believe it possible it may 
arise a few years after their total cessation. The headache resembles spinal 
irritation, also, in a curious and hitherto unexplained phenomena; commencing 
on the left half of the body, we occasionally meet with it also on the other side; 
but I have never discovered that it began there, nor is it ever restricted solely 
to that side. When both sides are attacked they are equally so, the left being 
by far the more painful. As another proof of its being spinal irritation, if 
further proof be necessary, we find it under two distinct forms, and these 
forms are easily distinguishable by the nature and extent of the pain. In the 
one, it is confined to the exact tract of the sub-occipital nerve, it is lancinating 
or shooting, intermitting, and chiefly felt at its termination in the integuments 
of the temporal region; when severe in this spot it is the clavus Jiysteincus. 
When the whole course of the nerve and its branches are implicated, the entire 
left side of the scalp is very tender, sometimes exquisitely so; this is the hemi- 
crania. It is singular how much this disease is confined to the left side of the 
head; we find sucli to be the fact in ninety-nine cases out of a hundred. It sel- 
dom reaches the aggravated form of clavus hystericus without being accom- 
panied with other well-known hysterical symptoms, which, of course, facilitate 
the diagnosis. 

Diagnosis. — This headache attacks females exclusively. I have never heard 
or read of men su9"ering from this kind of headache. It is only during the 
menstruating period of life that even females are liable. The pain is referred 
to the left side of the head; it is worse on the approach of the menstrual flow; 
it is found in the track of the sub-occiptal nerve. The course of this nerve is 
well known ; it accompanies the sub-occipital artery, emerging from the spinal 
canal ; it passes along the back of the head, midway between the mastoid process 
and the mesial line, sending branches to the integuments which cover the pa- 
rietal protul)erance, and terminating in the temporal region. Its course, from 
its exit to its termination, can oftentimes be accurately ascertained, from the 

• While writing the above, I referred to Dr. Tilt's work on Diseases of Females, first 
edition, and iu page 58, he gives the valuable fact that he found the right ovary afi'ected 
in only five out of seventeen cases. Now, it might be worth inquiry to ascertain 
whether the left had not been previously affected, but that the irritation was trans- 
ferred to the right, as we see in ophthalmia occasionally. 



1854.] 



Medical Pafliohgy and Tlierapeutics. 



231 



pain induced by pressing upon it. Although the head suffers, pressure may not 
always produce the pain, for it is intermitting. In general, however, pain may 
he thus detected in one of three places ; on the left side of the neck, where the 
head and vertebrje join, at the parietal protuberance, or in the temporal region; 
when concentrated in the last spot, it is the well-known clavus. It is sometimes 
painful in all three, and sometimes in its whole track. It is, however, rare that 
the tenderness is absent in the occipital region. The part suffers more when 
pinched than when pressed. Wh,en the branches as well as trunk suffer, we 
then have hemicrania, a most painful form, less intermitting than the other, and 
preventing the unfortunate girl from lying on the affected side. It is more 
commonly met in the unmarried female, from the twenty-second to the thirty- 
fifth year ; but the married females who are childless do not escape. 

This headache is chronic, intermitting, may continue for days, weeks, or 
months, then subside, and return after the lapse of months or even years. A 
first attack is seldom felt before the twentieth year, nor after the thirty-fifth. 
The pain is generally of a shooting kind, darting from the neck towards the 
temple, and never towards the neck, by which it is easily distinguished from 
odontalgic pain. Neuralgia of the left mamma (irritable breast), or of the se- 
venth or eighth intercostal (pleurodyne), frequently coexists. It is sometimes 
found in combination with the anaemic, but more rarely with the congestive 
headache. From caries of the body of a vertebra it is easily distinguished by 
the pain being superficial, being confined to the left side of the spine, by its not 
becoming worse when the head is flexed on the chest, nor by jumping, nor by 
pressing the head against the spinal column. 

This neuralgic pain sometimes accompanies the rotated spine. It is singular 
how often toothache is mistaken for headache, especially for this form. In both, 
the pain is described as shooting in the course of the nerves, but in toothache 
the pain shoots towards the neck and ear, leaves no tenderness of scalp, never 
goes so high as the parietal protuberance, and is more correctly discovered by 
learning that a paroxysm is brought on by food, sometimes when warm, at other 
times when cold. 

Treatment. — If the disease be not complicated, we can promise relief. The 
bowels should be kept open by regulated diet, and by aperients, such as castor 
oil, olive oil, lenitive electuary, powdered rhubarb, soluble tartar, or the com- 
pound rhubarb pill. If the bowels are obstinate, an enema of a pint of cold 
water daily answers the double purpose of removing the contents which may 
irritate the ovary, and as a local application to the organ chiefly in fault. The 
cold hip-bath is a valuable remedy when the constitution is vigorous, but all 
these things are inferior to sea-bathing. Stimulants should be abstained from, 
employment should be found for mind or body, but physical efforts are prefer- 
able. The sedentary position required by the needle, especially in solitude, is 
very injurious. A sinapism over the exit of the nerve gives great temporary 
relief; a vesicating plaster of cantharides is better, but it oftentimes leaves a 
mark, and therefore, on account of sex, age, and position in life, may be objec- 
tionable. A croton-oil liniment, made with one drachm of oil and one ounce of 
camphorated tincture of opium, and rubbed until pustules appear, is preferable, 
as it leaves no permanent blemish. The belladonna plaster, mixed with pow- 
dered opium, or a liniment of extract of belladonna, rubbed with mucilage, are 
useful and unobjectionable remedies. Speedy relief is occasionally afforded by 
veratrine or aconitine ointment, made with from four to six grains to half an 
ounce of spermaceti ointment. The finger used in rubbing should have a piece 
of bladder interposed. 

One ounce of tincture of aconite, with seven ounces of rose-water, is a safer 
remedy to trust to inexperienced hands than the veratria. The internal medi- 
cines are not so easily chosen. Tonics are frequently required, and they may 
be combined with anti-hysteric remedies. The disulphate of quinia may be 
oxhibit-ed in a strong infusion of valerian; compound iron pill, with assafetida 
in large doses, is very beneficial. If there be irritability of the stomach co- 
existing with profuse menstruation and leucorrhoea, pills of valerianate of zinc, 
half a grain three times a dp^y, with one drop of creasote, answer many inten- 
tions. If there be much debility, the sulphate of iron may be combined with 
infusion of valerian and ammonia, or the ammoniated tincture of valerian may 



232 



Progress of the Medical Sciences. 



[July 



be prescribed. The pain is sometimes so acute that some relief is quickly 
demanded, and half a grain of morphia will lessen the pain for a while until 
other remedies have time to act. For the leucorrhcea, one drachm of acetate of 
zinc to one pound of distilled water is useful as a lotion. But we are sometimes 
perplexed, for the tonic treatment is not the best for a full plethoric female ;• 
leeching or even general bleeding is required, but the cases are rare which 
require general bleeding. 

If the patient be not very weak, and there is much leucorrhoea and menor- 
rhagia, the treatment laid down by Dr. Tilt for subacute ovaritis should be 
adopted. He leeches in the menstrual interval, and then blisters the iliac 
regions ; but as his work is universally read, the treatment is well known. Sea- 
bathing, when practicable, should never be omitted. — Lancet, May 20, 1854. 

* 28. Hysterical and Spasmodic Cough. — Dr. Andrew Wood said, at a meeting 
of the Medico-Ohirurgical Society, March 1, 1854, that about a fortnight ago, 
in a public institution for the education of girls, one of the inmates was seized 
with a peculiar spasmodic cough, coming on in paroxysms every half hour or 
twenty minutes, and for some time he was at a loss ; but others of the girls 
becoming affected, Dr. Wood recognized an old friend, which had come under 
his notice in a kindred establishment about two years ago. About a dozen of 
the inmates were then affected, and on coughing made a sound resembling the 
cry of a turkey-cock. No remedy seemed to check the complaint, except re- 
moving those affected to their homes. In one case, where from the violence of 
the symptom the larynx was feared for, chloroform, then but newly introduced, 
had an admirable effect. In the present instance only three or four cases have 
occurred, those affected having been removed to separate houses — an opiate 
usually completing the cure. — Monthly Journ. Med. Sci. May, 1854. 

[A similar case occurred two years since at a boarding-school in Philadel- 
phia, and created considerable excitement in the neighbourhood.] 

29. Report regarding the Cases of Hydrophobia lohich occurred in France 
during the year 1852. By M. Ambroise Tardieu. (In the year 1850, the 
minister of agriculture and commerce, on the recommendation of the commit- 
tee of public health, sent a circular to every prefect in France, requesting him 
to give information regarding any cases of hydrophobia which might occur in 
his department. A number of reports were in consequence sent in, but as 
these were in some respects incomplete, a fresh circular was issued detailing 
more particularly the manner in which the cases should be recorded. From 
the information so obtained, M. Tardieu drew up a report regarding the cases 
which occurred in the years 1850-51, as well as in 1852. As the report for 
the year 1852 is much more complete than the others, we subjoin an abstract 
ofit):— 

1. The number of cases of hydrophobia which occurred in France during the 
year 1852 was 48. These were observed in 14 departments : the department 
in which the greatest number occurred was that of the Hautes Alpes (in the 
southeast of France, latitude between 44° and 45°); while the department of 
Lozere (also in the south, and having the same latitude as the other) came 
next. 

2. With regard to the sex ; 36 of the 48 cases were males, 12 females ; the 
proportion in the two preceding years was almost the same. 

3. The following table exhibits the ages of the subjects affected with hydro- 
phobia: — 



Below 5 years, in 


1852, 


3 


in two former years, 4 = 7 


From 5 to 15 




16 


14 = 30 


" 15 to 20 


(< 


4 


11 = 15 


" 20 to 30 




3 


9 = 12 


" 30 to 60 


li 


17 


37 — 54 


" 60 to 70 


11 


1 


7=8 


Above 70 


ti 





6=6 


Not mentioned 


it 


4 


0=4 



88 =136 



1854.] 



Medical Pathology and Therapeutics. 



233 



This table shows the incorrectness of the opinion which ascribes the disease to 
the effects of terror, fur it shows that 7 children under five years of age have 
been attacked. 

4. All the cases which occurred in 1852 originated in the bites of dogs, ex- 
cept one, where the bite of a cat was the cause of the disease. 

5. The situation of the wounds inflicted by the rabid animals was as follows 
in 48 cases: On the face 13 times; on the upper extremities 15 ; on the lower 
extremities 12 ; not mentioned 8., In two of the cases the disease was commu- 
nicated by pet-dogs which were accustomed to lick their masters' faces, and 
where excoriated lips were the seat of inoculation. 

6. In 40 out of the 48 cases, the date of the inoculation has been observed. 
It occurred in March, April, and May in 10 cases ; in June, July, a,nd August 
16 ; in September, October, and November 4; in December, January, and Feb- 
ruary 10. 

7. It seems a considerable number of individuals who are bitten by rabid 
animals escape the disease. During 1852, some observations were made on this 
point, and it appeared that out of 44 persons bitten about the same time 23 
only were attacked. 

8. The period of incubation of the disease was exactly noted in 20 cases. It 
was as follows: Less than a month in 8 cases; from 1 to 3 months 10; from 
3 to 6 months 1; 11 months 1. 

9. The duration of the disease in 20 cases was 2 days in 6 cases ; 3 days in 
8; 4 days in 5 ; 6 days in 1. 

10. The termination of confirmed cases of hydrophobia was constantly fiital. 
Of the 48 cases, it appears th-at only 27 came under this category, in the others 
the effect was merely local. In 12 of these 27 cases no precaution was taken, 
in 4 no mention is made of this circumstance. In 8 of the remaining 11 cases 
cauterization was resorted to immediately, in 3 at a late period. Of the 21 in- 
dividuals who escaped (see \ 7) cauterization was energetically performed in 
12 cases ; the details of the other 9 have been omitted. 

11. As to the mode of cauterization employed, the actual cautery was used 
in all the cases but 5, and these were treated by protonitrate of mercury, nitric 
acid, ammonia, or butter of antimony. In Germany, it has been proposed to 
excise the bitten parts, and then to wash the wounds with a solution of caustic 
potash. — Montldy Journ. Med. Sci. May, 1854, from Annales d' Hygiene, &c. 
January, 1854. 

30. Hydrophohia in a Cretin — Eemarkahle Development of the Intelligence 
during the Paroxysms of the Disease.- — The following curious case is related by 
M. NiEPCE. A. Chauvet, a cretin from birth, at the age of 17 years presented, 
in a marked degree, all the physical and mental characters of cretinism. He 
could only articulate a few words imperfectly. He had not sufficient intelli- 
gence to learn reading or writing, nor to understand the catechism. His affec- 
tions were little developed: he had some liking for his mother, but showed 
none for his brother. On the 10th May last, he was bitten by a mad dog; the 
wound was slightly cauterized with some drops of ammonia by a druggist, 
about an hour after the accident. Nothing was observed till the 27th July fol- 
lowing, about eleven o'clock, when Chauvet refused to eat or drink ; and two 
hours afterwards all the symptoms of hydrophobia made their appearance. 
From the commencement of this disease, to the great astonishment of every 
one, Chauvet spoke with much greater facility than he had ever done before, 
addressing those around him, and relating the sufferings which he felt. In the 
intervals of the paroxysms, he called his mother and brother, showing his affec- 
tion for them by the most tender caresses, and entreating them not to leave him 
alone. He caused the priest to be sent for, and on his arrival expressed with 
tears his bitter regret that he had never been able to learn the catechism. 
During the remainder of his illness, his intelligence became always lucid 
during the paroxysms of suffering, when he would put questions to those 
around him and give directions to them ; but as soon as calm or depression 
ensued, the natural state of his intellect returned. On the 1st August, acute 
delirium came on, during which he spoke frequently and with volubility, citing 



234 



Progress of the Medical Sciences. 



[July 



facts which had happened several years before, and to which he had never 
seemed to pay attention. The delirium lasted till night, when it was succeeded 
by deep coma. He died at five o'clock on the following morning. — Monthly 
Journ. Med. Sci. from Gaz. des Hop. Aug. 27. 

31. Hydrophotia Five Years after the Bite — Death — Autopsy. — [Though we 
confess our incredulity of the possibility of the incubation of hydrophobia 
being prolonged for five years, we copy the following case, as it is a curious 
one, and it presents a fair view of the opinions of various authorities in regard 
to that point.] 

The feature of greatest interest in the following case is the unusually long 
interval which elapsed between the infliction of the dog's bite and the outbreak 
of the symptoms. Before entering upon it, therefore, it may be well to glance 
at the facts and opinions previously recorded in respect to the possible length 
of incubation in the disease in question. Although, probably, the views enter- 
tained by the bulk of the Profession tend strongly in an opposite direction, yet 
there is on record a very large body of evidence in favour of the opinion that 
the incubation stage of hydrophobia maiy be prolonged over a series not only 
of months, but of many years — in fact, indefinitely. Romberg, in his work on 
"Diseases of the Nervous System, '' says: "An analysis of sixty authentic ob- 
servations has shown that the shortest interval between the introduction of the 
poison and the appearance of the disease is fifteen days, the longest from seven 
to nine months, and that the average period is from four to seven weeks.''^ Out 
of thirteen persons who were bitten in one day, by a mad wolf, and whose cases 
are described by TroUiet, the disease appeared in 1 between the 13th and 30th 
day, in 4 between the 30th and 40th, in two between the 40th and 53d, and in 
1 three months and a half after the bite. Lenhossek mentions two patients 
who were attacked respectively 6 and 9 months after the infection. Dr. Meade 
mentions an interval of 11 months, Bossiere of a year, and Nourse of 19 months. 
Dr. Hamilton considers 19 months, and Dr. Hunter 17 months, to be the longest 
intervals worthy of credit. Dr. Levin, in his "History of Diseases Transmis- 
sible from Domestic Animals to the Human Race,'' states, that the incubation 
period of hydrophobia may be only a few hours, or may be extended to many 
years. Dr. J. Hassinger has recorded a fatal case in the Transactions of the 
Vienna Medical Association, in which the disease appeared two years after the 
bite. A very carefully sifted case has been published by Dr. Bardsley, of Man- 
chester, in which it seemed certain that no less a space than twelve years had 
passed since the accident. In many of these almost incredible cases, it appears 
certain that the aff'ection possessed' all the symptoms of hydrophobia; and as 
it is admitted by almost universal consent, that the disease never occurs spon- 
taneously in the human subject, there is but one other source of falhicy to 
which we can turn. That source is the possibility of a more recent infection 
having occurred than the one mentioned by the patient. A severe dog-bite, it 
is allowed, is an occurrence not very soon forgotten; but then it must be borne 
in mind that a bite is not necessary to the production of the disease, and that 
a mere lick on an abraded surface will amply suffice. Mr. Lawrence mentions 
the following: " The Hon. Mrs. DuflP had a French poodle, of which she was 
very fond, and which she was in the habit of allowing to lick her face. She 
had a small pimple on her chin, of which she had rubbed off the top, and, 
allowing the dog to indulge in his usual caresses, he licked this pimple, of 
which the surface was exposed, and thus she acquired hydrophobia, of which 
she died." Here, then, is a source of contagion to which most individuals are 
more or less unconsciously exposed, and it is very possible that some of the 
supposed cases of extraordinarily delayed outbreak may be thus explained. 
There is one, however, which cannot be so dismissed, and which occurred 
under the exact circumstances requisite to afford an almost incontestable proof 
of the phenomenon alluded to. It is that published by Mr. Hale Thompson, in 
Vol. I. of the Lancet. The subject of it, a lad, aged 18, had been twenty-five 
months in close confinement in prison, and during that time had never been 
exposed to the bite of any animal. He had been bitten severely by a dog seven 
years before in the right hip, and the scar still remained. During the whole 



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Medical Pathology and Therapeutics. 



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period he was under observation, he was sullen, gloomy, and reserved, and was 
never known to look the person in the face to whom he spoke. Death occurred 
after a three days' illness, during which ''the most decided symptoms of hy- 
drophobia were manifested." In this case, as in the one we are about to 
record, great pain was complained of at the seat of injury. Observations such 
as the above must, we think, be held to make it extremely probable that the 
period of incubation in hydrophobia is quite an indefinite one, and that, in the 
following case, the history given might be fairly accepted as explanatory of the 
occurrence of the disease. 

Thomas Spink, a very muscular young man, aged 19, was admitted into 
Guy's Hospital, under the care of Dr. Hughes, on the evening of Monday, May 
15. A message had been sent previously, by the Surgeon in attendance, re- 
questing that some one would come to his house, in order to administer chloro- 
form, previous to his removal to the Hospital, as the spasms were so violent 
that he thought great difficulty would otherwise attend the attempt. A dresser 
accordingly went to the patient's house for that purpose ; but, finding that the 
chloroform seemed only to excite him, its exhibition was desisted from. Daring 
the journey, which was only a short one, every breath of air appeared to excite 
the most violent spasm about the throat. On arriving at the Hospital, at half- 
past nine in the evening, the man was seen by Mr. Stocker, the Resident Medi- 
cal Officer, and subsequently by Dr. Hughes and Dr. Gull. The latter gentle- 
man took a great interest in the case, and stayed with the patient during most 
of the time he was under care ; and in compiling the following, we had the 
benefit of some remarks upon it made by him on the following day. At first 
sight there was a wildness about the patient's expression, and an appearance 
of terror and alarm, which those who had ever before seen a case of hydro- 
phobia could not mistake. The least breath of air threw him into a violent 
paroxysm of spasm, which appeared mainly to afiect the pharynx, but in which 
the head was also thrown back, and there seemed some tendency to opistho- 
tonos. His conversation was generally wild and incoherent; but he could, 
when more quiet, answer questions, and stated his age and name, but, as it 
was afterwards found, not quite correctly. He complained of much pain in the 
left leg, and immediately below the knee, on that side, was the scar of an old 
bite. There was no lockjaw whatever; but, although he appeared very thirsty, 
and anxiously attempted to drink, yet he could not swallow a drop of fluid, 
violent spasm being immediately produced by the attempt. There was much 
adhesive and frothy saliva about his mouth, which he was constantly engaged 
in the attempt to spit out. Gasping eructations frequently occurred, but there 
was no actual vomiting. He was in the greatest alarm, and appeared from his 
expressions to be in fear that it was intended to murder him. Respiration was 
constantly attended by sighing efibrts, and almost by shuddering ; his condi- 
tion in this respect much reminding the bystanders of that induced by a sud- 
den plunge up to the neck in cold water. At first, it was not thought necessary 
to confine him, but afterwards it became needful to do so, as on one occasion, 
watching his opportunity, he had thrown himself out of bed, and sprung vio- 
lently against a window which was near. After this, his arms were tied down 
to the sides of the bed. His pulse was rapid, and subject to sudden alterations 
in frequency, varying in the course of a few minutes from 100 to 130; the skin 
was warm and moist, and the pupils widely dilated. 

The remedy first tried was the Indian hemp, the extract of which (obtained 
fresh from Squires's), in the enormous dose of ten grains, was exhibited by in- 
jection into the rectum. The first quantity was almost immediately expelled, 
but the second was retained. It appeared, however, to exert not the slightest 
effect in controlling the tendency to spasm. The paroxysms continued to recur 
almost constantly, and were induced by the slightest causes. At about two 
o'clock A. M. it was decided to exhibit chloroform. The man resisted the 
attempts to make him inhale it, tossed his head about (he was strapped down), 
and even made an efi"ort to bite the hand of the administrator. The first effect 
was to excite and render the paroxysms much more violent and constant ; as 
insensibility was induced, however, the tendency to spasm subsided, and ulti- 
mately the patient lay quite quiet. It was noticed that his pupils, which pre- 



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[July 



viously had been widely dilated, contracted when under the influence of the 
chloroform. The inhaler being removed, it was found that the effect of the 
anjBsthetic was never prolonged more than a few minutes at a time, after which 
the spasms again began to occur. With short intermissions, the patient was 
kept under the influence of the remedy for more than an hour, when, on 
account of the extreme collapse, it was deemed necessary to suspend it. The 
pulse was now not perceptible at the wrist, and the surface Avas cool and 
clammy. After the chloroform was laid aside, some returns of spasm took 
place, but not violently ; the pulse never became perceptible, and the patient, 
after gradually sinking, died about a quarter to four A. M. A few hours pre- 
vious to death, there had been noticed some emphysema of the cellular tissue 
in the root of the neck, caused, no doubt, by rupture of the trachea or some 
part of the larger bronchial tubes during spasmodic closure of the glottis. 

Of the numerous observers who witnessed the symptoms just described, there 
were none, we believe, who felt any doubt as to the name by which the disease 
should be designated. As distinguishing it from mania, there were the attacks 
of spasm, the great susceptibility of the external surface to impressions, and 
the incapability of swallowing fluids. The delirium was one of terror and 
extreme fear, very distinct from the fierce and violent raving usually present 
in phrenitis. From tetanus, its difference was not less well marked. There was 
neither trismus, rigidity of the abdomen, or tonic spasm of muscles, nor did 
the paroxysmal attacks involve the muscles of the extremities. In tetanus, the 
intellect is almost invariably clear to the end; here, it was clouded by delusions 
of a peculiar and pathognomonic character. The post-mortem examination 
was performed on the following morning by Dr. Habershon, and was productive 
of little more than negative results. Having briefly specified them, we will 
next give the history of the case previous to admission into the hospital. As 
much of the interest of the narrative depends upon the degree of confidence 
which may be placed in the history, we may state that its facts were ascer- 
tained by Dr. Gull from the father of the patient by a very careful cross-exami- 
nation, and that they obtained the full credence of that physician. 

Autopsy, twelve Jiours after death. — There was great post-mortem rigidity, 
all the muscles being hard. With the exception of the hands, which were 
rigidly flexed, there was no distortion of any of the extremities. On opening 
the head, the veins or the meninges were found full of blood, and the brain 
substance itself presented a little more of vascularity than is seen in the ave- 
rage of examinations. The whole of the pharynx was deeply congested, and of 
a slight bluish tinge; the boundary of the congestion was definite, and termi- 
nated at the commencement of the oesophagus. The tonsils were of usual size. 
The left side of the heart was firmly contracted, and the blood was universally 
fluid. The posterior parts of the lungs were loaded with blood, and some parts 
presented the characters of incipient lobular pneumonia. There was inter- 
lobular emphysema about the root of the left lung. The cord was taken out, 
but, with the exception of some very questionable softening of a part in the 
middle dorsal region, it presented nothing morbid. Beyond general congestion 
of the abdominal and thoracic viscera, distension of the intestines with gas, 
and a dry condition of the peritoneal surface, no other departures from the 
healthy condition were observed. The surface of the corpse was carefully 
examined for any traces of recent wounds or abrasions, but none were dis- 
covered. 

Previous history of the case. — The father of the young man was by trade a 
bricklayer, and his son had worked partly with him and partly as a " tumbler" 
at fairs. Five or six years ago, the boy, then aged about 13, had been severely 
bitten in the left leg by a strange pointer bitch. The dog had puppies at the 
time, and the occurrence took place in the road.^ The father of the boy wit- 
nessed the occurrence, and remembered it well, because he had afterwards to 
dress the injured part. Nothing whatever was known as to the history of the 

' As no history of the dog could be got at in this case, it may be worth noticing, 
tliat during the few weeks immediately subsequent to parturition, dogs are, according 
to the observations of Youatt, peculiarly liable to madness. 



1854.] 



Medical Pathology and Therapeutics. 



237 



dog. After the wound had healed, the boy never again complained of it, and 
he manifested no alteration in temper or manner. He was usually of quiet 
habits, and not much addicted to drink. He had always lived at home, and 
the father felt certain he should have known if any bite, wound, or other injury 
had occurred to him since the one mentioned. He had enjoyed excellent 
health, in every respect, until Friday, the third day previous to his admission. 
On the afternoon of that day (he had been staying at home, being out of work,) 
he went to sleep, and woke up in the evening, appearing disturbed, and stating 
that he had a very bad dream. He afterwards took some tea, and then went 
out for awhile. At night, he complained of a severe headache. On Saturday, 
he still complained of not being well, but, in the afternoon, walked with his 
father a distance of some miles, to " tumble" at a neighbouring village. Late 
in the evening, he commenced the practice of his evolutions, but, after having 
stood once on his head, complained that it had hurt him so that he must give 
it up. During the walk home, his father noticed that his limbs seemed weak, 
and the journey took them many hours. Throughout Sunday he stayed in the 
house, still complaining of " splitting headache,"'' and appearing very ill. He 
could, however, SAvallow fairly, and had no noticeable difficulty in doing so. 
Late in the evening he got up, and went alone to a neighbouring public-house 
to get some beer, which he drank, but, as the landlady who served him after- 
wards stated, with the greatest difficulty, as "it seemed as if it would have 
choked him." On Monday morning he said he could not drink, and took only 
a little sopped biscuit, which he appeared scarcely able to get down. In the 
afternoon of that day the attacks of spasm began to occur. He exhibited the 
greatest terror of some impending mischief, although perfectly conscious. A 
medical man who had been sent for entering the room, he begged him not to 
approach, as he could not, he said, help striking him if he did. These symp- 
toms becoming rapidly aggravated, he was, as we have already seen, conveyed 
to the hospital late in the evening. 

Having already entered so fully on the incubation question, we have not 
much to add in the shape of comment on the above. The premonitory symp- 
toms of the outbreak, the duration of the attack, and the nature of the illness, 
presented nothing different from the ordinary course of hydrophobia. It is 
worthy of note, that the lad had manifested no form of nervous disease what- 
ever during the long interval subsequent to the bite. The fatal attack could 
not in any way be attributed to fear or apprehension, since he did not appear 
to have in the least anticipated any ill consequences from his accident. The 
effect of the chloroform inhalation would seem to have been almost precisely 
similar to that which we have noted in many of the more acute cases of tetanus, 
which have been mentioned in the series we are at present engaged on. The 
drug was efficient in allaying the morbid irritability, and in completely con- 
trolling the tendency to spasm, but exercised no preventive influence. Its 
effects rapidly passed off when inhalation was relinquished, and the vital 
powers of the patient failed as fast as they could have been expected to do had 
it not been used. — Med. Times and Gaz. May 27, 1854. 

32. Morbid Changes in the Mucous Membrane of the Stomach. — Dr. Hanfield 
Jones read a paper on this subject before the Royal Medical and Chirurgical 
Society, May 23, 1854. The first part of this communication comprised a de- 
scription more particularly of the minute glandular structure of the mucous 
membrane of the stomach, in which the author corroborated the account given 
by Kolliker. On first commencing his researches into this subject, he was not 
aware that lenticular or solitary glands had been seen in the mucous membrane 
of this viscus. The author, not imagining they could be normal structures, 
had at first viewed them as simply nuclear deposits, supposing they were of 
new formation. Kolliker had observed that these lenticular glands did not 
constantly occur in the stomach of adults, even though they might be possibly 
always present in those of children. In very many cases he had met with no 
traces of them ; in others they were seen to be extremely numerous, covering 
the whole surface of the stomach; yet the thought could hardly be excluded, 
that the morbid conditions of the part, which were ahvays present, had not had 
No. LV.— July 1854. 16 



238 



Progress of the Medical Sciences. 



[July 



something to do with their formation. The author thought it difficult to fix 
any exact limit to the healthy development of these glands. He considered the 
gastric tissue in its most normal and efficient state when there were but few of 
these glands or nuclear masses, and when those that existed did not encroach 
materially upon the tubular or gastric glands of the stomach. He thought 
great individual varieties might exist ; that they were naturally larger and 
more numerous in some individuals than in others. He ventured to think that 
these solitary glands, and their groups in the intestines (Peyer's patches), had 
really no use, and fulfilled no function in the human body, but existed in a 
rudimentary state, in obedience to the law of unity of type. They might be 
regarded as portions of undeveloped embryo substance, existing in inverse ratio 
to the surrounding specially organized tissues, and with this view their simple 
nuclear structure, so common in embryonic parts, was very accordant. Tlie 
author thought that the epithelial contents of the tubular glands were thrown 
off during digestion, and formed an important constituent of the gastric juice, 
probably the so-called pepsin. The evidence of this rested on examination of 
the stomachs of animals killed while digestion was proceeding, and of a man 
who died suddenly soon after a meal. The following deviations from the typi- 
cally healthy condition of the stomach were mentioned as examples of morbid 
changes: — 

1. Nuclear masses. It was doubtful what degree of development of these 
was to be considered as surpassing the physiological limit ; but observation 
proved that they became both hypertropbied and atrophied, and the latter 
seemed to take place by a kind of liquefying, so that a cavity was formed con- 
taining a clear fluid and some nuclear corpuscles. 

2. Diffused nuclear formation. The effect of this was, that the tubes became 
more or less atrophied and obscured by interstitial deposit. 

3. Iiitertuhvlar fibroid formation. The tubes became atrophied by the pre- 
sence of a fibroid or granular deposit, in which some altered vestiges of the 
tubes might be brought into view by acetic acid. 

4. The tubes appeared to decay spontaneously, but not from the presence of 
new fibroid tissue. 

5. Black pigmentary deposit, occasionally within the tubes, more often be- 
tween them; sometimes yellow pigment was found; both might be regarded as 
altered heematine. 

6. Cystic formation, -prodviced in one of three ways : First, a nuclear mass 
liquefied and left a cavity ; secondly, while atrophy of the tubular glands was 
going on, a portion of one became distended; thirdly, a cyst was produced as 
a large vesicle, a true new formation. 

7. Mammillation, usually affecting the pyloric region. 

8. Gathering up of the loioer parts of the tubes, so as to form a group of con- 
volutions like the acini of a conglomerate gland. 

9. Unhealthy condition of the epithelium of the tubes, occasionally exhibiting 
the characters of a fatty degeneration. 

10. Self digestion was of frequent occurrence, and mostly confined to the 
splenic region ; the mucous membrane was more or less deeply coloured, 
thinned, smooth, and semi-translucent. In extreme cases the nerves and ves- 
sels were seen altered, as when treated by strong acetic acid. 

11. Small dark-red, circumscribed spots, manifestly the result of hemorrhage; 
ulceration often took place in these. 

12. The tenacious adhesive mucus of gastric catarrh. Its microscopical cha- 
racters were very clearly described. 

The author had observed torulee in the mucus of the stomach of a diabetic 
patient. The paper was accompanied by a table of one hundred cases of j^osf- 
morteni examinations, in which the morbid changes in the mucous membrane 
of the stomach were fully and minutely described, together with an analysis 
of these cases, in which the influence of age and sex, habit of life, &c., were 
considered, as well as the frequency of the several morbid changes already 
enumerated. Eight drawings, executed by the author, illustrated very intelli- 
gibly the diseased conditions which the microscope had revealed. — Med. Times 
and Gaz. June 3, 1854. 



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Medical Pathology and Therapeutics. 



239 



33. Waxy Degeneration. — This peculiar change in organs has been recently 
made the subject of discussion in the Physiological Society of Edinburgh. It 
is observed in the spleen, the kidneys, and liver, and indicates an important 
constitutional cachexy. The organ aflFected with it is firm, its section is smooth, 
and its feel hard like wax. 

In the liver, studied microscopically, according to Dr. W. T. Gairdner, there 
is a change in the entire structure, but chiefly in the glandular epithelia, which 
are compressed, irregular in form, and have atrophied nuclei. They are also 
altered in a manner which can hardly be described but easily recognized after 
being once seen, presenting a peculiar liormj refraction, and giving the idea of 
a substance much denser and more resistant than the normal elements of which 
these cells are composed. Sometimes the cells cohere in masses, sometimes 
they are very small, at others as large as the ordinary cells. 

In certain forms of Bright's disease of the kidney, a precisely similar altera- 
tion takes place in the histological elements of that organ ; but here, the vessels, 
and particularly the arteries and the Malpighian tufts, are the first portions 
distinctly affected. 

In the spleen, on the other hand, the most marked change is in the contents 
of the sacculi. This change in the albuminous tissues is not always confined 
to the original structures of the body: old deposits in serous membranes and 
tubercle often exhibit it, and even cancer sometimes undergoes this change, 
when the cancer cells cannot be distinguished from those of the liver, except 
by their lighter colour. 

In the spleen, according to Dr. Sanders, under a power of 250 diameters, the 
nature of the v/ax}^ degeneration can be distinctly seen in their sections. The 
Malpighian bodies, forming rounded transparent granulations, appear as clear 
spaces surrounded by the red pulp. The normal corpuscles of these bodies are 
found converted into, and replaced by masses of a colourless, dense, highly 
translucent, homogeneous material. At first, these masses appear to exhibit 
no structure of any kind; but, on careful examination, the outlines of irregular 
cells may be discerned. 

This waxy degeneration" is a pathological change of great importance. 
It is not now observed or noticed for the first time, but is well worthy of a 
more careful study than has hitherto been bestoM'ed on it. — Assoc. Med. Journ. 
March 24, 1854. 

34. Metastasis, in its Practical Bearings. — Mr. Hunt read a paper on this sub- 
ject before the Medical Society of London (April 22, 1854), the object of vrhich 
was to inquire in what manner, and to what extent, the knov/ledge of such a 
principle or contingency should modify or restrain the practice of the physician 
and the surgeon. He (Mr. Hunt) stated that metastasis did not appear to be 
well understood, and that a doctrine had been deduced from it which appeared 
to have no rational foundation. Authors of repute had described certain local 
diseases which were known to be subject to metastatic changes as being salu- 
tary or protective to the system, so that they could not be cured without danger 
tu more important organs. The diseases thus described as "salutary'^ had no 
pathological character peculiar to themselves, but it happened that they were 
all, to a certain extent, difficult of cure. They were — gout, asthma, hgemor- 
rhoids, fistula, ulcers of the legs, otorrhosa, and certain chronic eruptions. It 
had been argued that, as we were able to relieve internal congestion by exter- 
nal counter-irritation or artificial discharges, so the suppression of spontaneous 
morbid irritation or discharge was liable to induce disease of the viscera. But 
this opinion was contrary to physiological principles, and it was not supported 
by facts. Still, in certain patients of weak constitution and peculiar idiosyn- 
crasy, it did occasionally happen that disease of the surface suddenly receded, 
and the head, heart, lungs, or some other organ, became alfected ; and the 
question for discussion was, whether, in cases where there was reason to ap- 
prehend metastatic action, it was best to leave the disease alone, or whether 
there was any safe mode of treating it. Where metastasis had resulted as an 
apparent consequence of medical or surgical treatment, it might be suspected 
that the treatment was improper. Thus, the immersion of a gouty foot in cold 



240 



Progress of the Medical Sciences. 



[July 



■water had been followed by hemiplegia. Such metastasis probably would not 
have occurred had the attack of gout been treated constitutionally ; and this 
principle would apply in all cases. Local diseases, and especially the eruptive, 
should be treated by careful attention to the state of the general health. Even 
in local diseases of local origin, the health might become secondarily affected, 
and it might then be unsafe to rely on local remedies. It had rarely occurred 
to him (Mr. Hunt) to meet with a case of skin disease, or ulcer, or fistula, in 
which the general health had improved under the progress of the local disease. 
The reverse very commonly occurred: patients suffered in their general health 
in consequence of local irritation, and recovered when the source of that irri- 
tation was removed. Still, in all cases, it was better to treat local disease by 
internal remedies, of which evacuants should form a chief part. Under this 
practice, he (Mr. Hunt) has never once seen the recession of eruptions or the 
healing of ulcers followed by any consequences of a serious nature. On the 
contrary, if the health had been previously in any degree deranged, it had 
generally been found much improved by the treatment. The author observed, 
however, that in those rare cases in which a strong disposition to metastasis 
existed, there was some peculiarity of constitution in the patient which resisted 
the ordinary influence of medicine. These cases, being rare, often found their 
way into print, and therefore became apparently more numerous than they 
really were. But their practice must be guided, not by the exception, but by 
the million of cases which follow the general rule ; and we might greatly ques- 
tion the existence of any "salutary" disease, which, as a safeguard to health, 
demanded a moment's consideration at their hands. — Lancet, April 29, 1854. 

35. Fatal Effects of imperfect Union of the Umbilical Vein after Childbirth; 
Jaundice as the Result of the imperfect closure of the Ductus Venosus. — Mr. Henry 
Lee read to the Physiological Society March 18, 1854, the particulars of two 
cases, one under the care of Mr. Willing, of Hampstead: the other under the 
care of Dr. Herapath, of Bristol. In the first, jaundice was the most promi- 
nent symptom, and commenced immediately after birth. Six days after the 
separation of the funis (in which process there was nothing abnormal), slight 
hemorrhage made its appearance. The blood passed was of a thin serous 
character, scarcely discolouring the linen upon which it was received, and, 
when dry, not stiffening it. The bleeding continued for two days in spite of 
every attempt to avert it. It then stopped after the umbilicus had been 
plugged by cobweb. The little patient, however, shortly afterwards sank. On 
a post-mortem examination, the umbilical vein, one umbilical artery, the duc- 
tus venosus, the ductus arteriosus, and the foramen ovale, were all found open. 
No coagula were found in any part of the body, and the blood discharged from 
the vessels, both before and after death, had evidently lost its power of coagu- 
lation. It appeared entirely deficient in fibrin. There was no appearance of 
inflammation of the lining membrane of the umbilical vein, although the struc- 
tures around, near the umbilicus, were somewhat condensed and thickened. 
The jaundice in this case was attributed by Mr. Lee to the blood from the 
vena porta having passed through the ductus venosus instead of circulating 
through the liver. When the natural circulation through the ductus venosus 
at childbirth ceases, if that vessel remains open, it affords a ready passage to 
the blood from the portal system, and thus the blood from which the bile 
should be secreted may never get to the liver at all. Under such circum- 
stances, the bile would necessarily accumulate in the system. Instances have 
been related in which the secretion of bile went on perfectly well where there 
Svas no vena porta; but there were cases in which the hepatic artery was very 
much larger than natural, and supplied the amount of blood required for secre- 
tion as well as for nutrition. In Dr. Herapath's case, some blood escaped 
from the umbilicus at the time the penis separated, and shortly after birth the 
child became jaundiced. It was subsequently attacked with erysipelas, and 
secondary deposits formed in various parts, but not in the lungs. This was 
accounted for by Dr. Herapath, from the circumstance, discovered on a post- 
mortem examination, that the foramen ovale had remained open. It was 
therefore thought that the vitiated stream of blood from the lower cava had 



1854.] 



Surgery. 



241 



been directed, as in the foetal circulation, by the Eustachian valve, through 
the foramen ovale to the left side of the heart, and thence to the system gene- 
rall}^ ; whereas the blood from the superior cava, which had not been directly 
contaminated, alone passed into the right ventricle, and was thence sent to the 
lungs. In this case the umbilical vein was found filled with curdy, puriform 
fluid, and afforded a strong contrast to the first case, in which the vein con- 
tained only a very delicate filamentous coagulum, and presented within no 
other sign of disease. The difi"erences observable in the two instances in this 
respect supported, as Mr. Lee believed, the doctrine which he had now for 
some years advocated — namely, that the puriform fluid found in the vein in 
such cases was formed by the softening of the fibrin and of the coagula which 
the vessels contain ; and that where, from whatever cause, no such deposit of 
fibrin or coagulation of the blood occiirSj there no puriform fluid would be 
found in the vein, and none of the ordinary signs of inflammation of the lining 
membrane of the vein would be present. 

36. Portion of Intestine discliarged after Intussusception. — Dr. Paterson, of 
Leith, exhibited to the Medico-Chirurgical Society of Edinburgh a portion of 
intestine, still invaginated, about ten inches long, which had been passed by 
a patient of his twelve days after the occurrence of the symptoms of ilius. 

The patient, a girl, nine years old, made a perfect recovery. The disease 
began after an attack of dysentery. Much vomiting and great prostration of 
strength occurred at first ; on the fifth day, a large quantity of bloody serum 
was passed by stool, and without any feculent matter; on the seventh day, a 
small quantity of feculent matter was passed, and occasionally till the twelfth, 
when a perfect relief occurred to all the symptoms on the passage of the large 
portion of intestine shown to the Society. The treatment which was pursued, 
was the application of morphia to the blistered surface of the abdomen, and 
opium by enemata, as recommended by Dr. Evans, of Carlisle. (See Monthly 
Journal for January, 1854.) 

Dr. Simpson said, that he had seen the case along with Dr. Paterson, in which 
there was immense distension of the belly ; indeed, from the great enlargement 
of the cutaneous veins, the vena cava appeared to be obliterated by the pres- 
sure. Dr. W. Thomson, in his collection of cases (see Edinburgh Medical and 
Surgical Journal, vol. xlvi. p. 102), had only given two instances of the disease 
in patients so young, and none in which a double invagination had taken place, 
as, on examination of the preparation, appeared to have been the case in the 
present instance. — Monthly Journal of Medical Science, March, 1854. 



SURGICAL PATHOLOGY AND THERAPEUTICS, AND OPERATIVE 

SURGERY. 

37. Phlebitis, especially in connection idth the deligation of Veins. — Mr. Wee- 
den CooKE, in a paper read before the Harveian Society, began by referring 
to the influence of fashion in both medicine and surgery, and stated that 
"many of the novelties suggested as means of relief, fade into deserved 
oblivion; others gain a temporary notoriety, and swim upon the stream for 
a time ; whilst a few remain as lasting and glorious additions to our esta- 
blished means of thwarting the influences of accident and decay in the human 
frame." The revived and improved practice of vein-tying seemed to require 
consideration as to the notoriety of receiving it into the legitimate modes of 
treatment, and in order to bring the former and the present methods of per- 
forming this operation into juxtaposition, the author recited the experiences of 
Sir Everard Home, Sir Astley Cooper, and Sir Benjamin Brodie, describing 
the incision plan of the former surgeon, and the subcutaneous division of the 
vein, performed by the last of these eminent men ; and the ill success attend- 
ing these operations, so much so that they were repudiated and abandoned by 



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all surgeons at that time, from the frequency of the alarming symptoms of 
phlebitis and depositions of pus in various parts of the body. Sir A. Cooper 
was so impressed by the fatality of his own cases that he declared to his class 
" he would rather have his femoral artery tied than his great saphena." It 
was also the opinion of this great surgeon that when the operation does not 
prove fatal, its ultimate effects are perfectly nugatory, and this opinion is 
maintained to the present day by Sir B. Brodie, who, in a recent conversation 
■with the author, stated that if one vein be oljliterated, another will take on the 
varicose action, and so after a short time the evils for which this dangerous 
proceeding is adopted, are renewed. The author then passed in review the 
various writers upon the pathological causes of phlebitis, as occurring trauma- 
tically or idiopathically, and gave especial praise to the elaborate paper on 
this subject, by Mr. Arnott, in the fifteenth volume of Medico- Chi rvrgical 
Transactions, and to the investigations of a more recent date of Mr. Henry 
Lee. "Although the deligation and division of veins was abandoned, phle- 
bitis was still witnessed, arising from various causes. Venesection, which at 
that time was called the sheet-anchor in all inflammatory affections, was the 
most prolific means of providing subjects for inquiry. The secondary effects 
of amputation, and the excision of tumours : the purulent deposits in the vis- 
cera, after injuries to the head, as well as the phlegmasia dolens of parturient 
women, all yielded evidence of the dangerous character of this disease, and the 
tendency to diffuse itself over the whole system. The author then referred to 
ten fatal cases of phlebitis after venesection, reported by 3Ir. Arnott, and 
mentioned one at present under his own care in the Royal Free Hospital, 
where obliteration above and below the incision took place, and a deposition of 
pus over the wrist, attended by adynamic fever, was the result: this patient 
recovered. Having referred to the recorded cases of phlebitis, from tying 
patulous veins during operation, the author mentioned one that had occurred 
to himself. The patient was an old man of sixty-eight, suffering from an ex- 
tensive epithelial cancer of the hand and wrist, for which amputation was per- 
formed: a vein bled very freely, and loss of blood being most undesirable, 
from the low condition of the patient, Mr. Cooke put a ligature upon it. Four 
days after, the vein became highly inflamed, and a certain amount of slough- 
ing of the stump ensued. On the eleventh day the calf of the right leg became 
inflamed, and the inflammation extended up the saphena, into the thigh. 
Constant fomentation kept the inflammation in abeyance, and no points of 
suppuration were formed, although the leg remained oedematous for some time. 
He was, however, discharged, with the stump quite healed, leg free from 
inflammation, and able to walk tolerably well, in five weeks, and has since 
remained well. This case occurred a year and a half ago. The author sug- 
gested that the actual cautery should be used for staying venous hemorrhage 
in such cases, rather than the ligature. Passing on to the consideration of 
the more modern practice of the use of potassa fusa and the Vienna paste, in 
obliterating varicose veins, Mayo's cases were referred to. and Mr. Arnott had 
stated to the author his experience of this proceeding, which went to show that 
if it be used only to produce a coagulum in the vein, it acts beneficially; but 
that if the slough extends to the vein itself, the products of this action will 
most probably get into the circulation, and alarming secondary deposits will 
be the result. The difficulty of controlling the action of these caustics within 
exact bounds must limit their use very much, for who can be sure of effecting 
this? The still more recent and most approved mode of obliterating varicose 
veins is by the needle and twisted suture of M. Davat ; but as yet no convinc- 
ing set of cases has been published showing its immunity from the dangerous 
consequences seen to proceed from other operations on the veins, but, although 
not published, a great number of cases have been so treated, and Mr. Fergus- 
son, in a letter to the author, states that he has employed the needle and 
twisted suture for the last fifteen or eighteen years, for the purpose of oblite- 
rating varicose veins, without any bad results. "Our excellent president, Mr. 
Coulson, is in the habit of using this means of obliterating varicose veins fre- 
quently, and even allows his patients to walk from his house to their houses 
•without ill effects." Mr. Arnott also informed the author that he occasionally 



1854.] 



Surgery. 



243 



employed this mode of treatment, but always with the precaution that the 
thread did not pierce the coats of the vein, but only remained sufficiently long 
to obtain a firm coagulum. With this wise proviso the operation may become 
an innocuous one, but, as it is customary to allow suppuration of the coats of 
veins, cases were not few in which phlebitis of a most alarming character has 
been set up. One of these occurred whilst the author was house-surgeon at 
the Royal Free Hospital, amongst Mr. Gay's patients. The needles and 
twisted suture were applied to the saphena at several points, phlebitis came 
on in the leg and thigh, subsequently there was deposition of pus in the 
shoulder-joint, and after that the lungs were attacked, and he spat fetid pus; 
but by good living and good treatment he pulled through, though certainly 
with much difficulty, and the effects remained for a long time. The responsi- 
bility of the surgeon who runs these probable risks fur effecting a purpose 
which may be obtained by rest and constitutional treatment is tremendous ; 
and, even though forty-nine cases out of fifty escape evil results, we are not 
justified in placing the fiftieth in so perilous a position. The author then 
referred to Mr. Henry Lee's mode of tying and dividing the vein, and thought 
this more complicated procedure as much, if not more, objectionable than the 
needle and suture, and quoted from The Lancet a case in which much second- 
ary mischief had resulted from this operation. Having shown the occasional 
unhappy consequences of obliterating veins by operations, it remained to indi- 
cate a few of the means of relief, both local and general, which would obviate 
the necessity for these measures. Continued rest in the recumbent position, 
with an occasional batch of leeches over the inner condyle of the femur, are 
the prime requisites. Blue -pill and dandelion, with a brisk purge now and 
then, are the medicines of most service ; and Bourjeaurd's beautiful elastic 
contrivances, with or without a strip of soft leather, spread with soap and ad- 
hesive plaster, to support any particular bunches of veins, afford all the requi- 
site local treatment to obviate the possibility of sudden rupture, and remove 
pain. The constitutional symptoms and treatment of phlebitis were further 
illustrated by two cases occurring in the author's practice. In the first, a 
young gentleman from Ceylon, it arose from getting wet, and required highly 
stimulating treatment with bark, quinia, chlorate of potash, and opium, from 
the commencement of the attack. In the other case, that of a young robust 
surgeon, it was developed by sitting on damp grass after a hard day's shoot- 
ing, and required in the first instance antiphlogistic treatment ; but subse- 
quently, when the pus had formed, it was necessary to stimulate largely, and 
give the same medicines as in the first case. Much benefit was attributed to 
the chlorate of potash, given in fifteen-grain doses, three or four times a day, 
Seeing the occasional danger attendant on any operation for obliterating veins, 
and the certain return of the diseased condition, the author considered that, 
with our local and constitutional remedies at hand, we were not justified in 
exposing our patients to this risk, and expected to see vein-tying a second time 
fall into disrepute. — Lancet, May 27, 1854. 

38. Popliteal Aneurism; long-continued compression — eventual solidification of 

the Sac. — Thomas A , aged twenty-eight years, was aduiitted into Guy's 

Hospital, 31st Aug. 1853, under the care of Mr. Poland, who was officiating 
for Mr. Hilton. 

Description and History. — The patient is a strong muscular man, with dark 
hair and eyes. From the age of twelve years till twenty-two, he was engaged 
as a smith, since then he has been employed as a carman. The man has had 
a good deal of wrestling, and was reckoned very dexterous; his health has 
been good, the only illness he remembers being an attack of scarlatina followed 
by dropsy, when he was about nine or ten years old. About two months be- 
fore admission, on getting into bed one night, the patient felt a sudden pain of 
a pricking and darting description in the right ankle, which continued for 
some time, and was very severe. He looked upon this attack as one of gout, 
and fell asleep ; but the next morning was again annoyed by returning pain, 
which, however, soon afterwards passed away. From this time the uneasiness 
frequently recurred, and gradually crept upwards, involving the calf of the 



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leg, and ultimately settling in the popliteal space. The pain would generally 
come on when the patient was at rest, and moving about, affording him relief. 
It went on increasing, and prevented him from sleeping, and he found no alle- 
viation but in walking about. 

A practitioner mistook the swelling in the popliteal space for a chronic abr 
scess, and advised the application of tincture of iodine. This caused much 
distress, and the patient eventually applied for admission at this hospital. 

State on first Examination. — On applying the fingers to the popliteal space, 
a swelling may be detected ; it is about the size of an orange, elastic, and pul- 
sates forcibly ; it communicates to the finger a peculiar thrilling sensation, 
and the pulsations are synchronous with those of the heart. A very slight 
amount of pressure on the femoral artery suffices to arrest them, and when the 
compression is continued, the sac can easily be emptied ; it appears rather thin, 
and v.'hen the pressure is suddenly removed, the blood rushes through it again, 
giving a very unpleasant and even painful sensation to the patient. He, 
indeed, yeeZ* the blood as it suddenly flows down the artery, whilst a very dis- 
tinct bruit de soufflet can be heard on applying the ear to the tumour. The 
patient complains of pain when the swelling is handled, most of the uneasiness 
being around the knee. The pulsations can easily be seen by raising the leg. 
Another case of the same kind being treated at the time by pressure, under the 
care of Mr. Poland (to which we shall shortly allude), the latter decided upon 
using the same remedial means in this case. 

September 1. — The usual apparatus was employed, consisting of the com- 
mon clamp, so constructed that the pressure might be graduated, and the 
weight for the groin. Some difficulty was experienced in bringing the pad of 
the clamp to bear exactly on the artery, and as the weight of the cylinder 
pressing upon the artery in the groin was quite sufficient to control the flow of 
blood, the clamp was only used occasionally dul-ing the day. 

The pressure caused the veins of the whole leg and thigh to become very 
prominent, and the parts about the knee swelled up considerabl}''. A tingling, 
pricking pain was experienced down the thigh, and there was also partial 
numbness; but these sensations were less disagreeable than the pain in the 
popliteal space when the pressure was off. The bowels were ordered to be 
cleared with calomel and colocynth. 

Second day. — The patient did not get much sleep last night, but, upon the 
whole, has rested better than on previous occasions. The weight in the groin 
was kept on most of the night; the knee is very painful; the tumour much 
the same. 

Third day. — Bad night again. During the whole of the preceding day pres- 
sure was kept up by means of the weight and the clamp, which latter was 
arranged so as to act properly. The patient was seen frequently by Mr. 
Poland and by the dresser, and managed very nicely to alternate the pressure 
himself. Oxide of zinc to be powdered over the parts pressed upon. Pulsa- 
tions of the tumour somewhat lessened in force ; other matters much the same. 

Fourth day. — The patient did not sleep well last night, and will take a grain 
of opium this evening. The pressure was kept up all the preceding day as 
before ; but the man complains of a good deal of pain at the inner side of the 
knee-joint, when the articulation is handled. The tumour is decidedly firmer 
to-day ; the pulsations not quite so forcible, but the thrilling sensation is still 
communicated to the hand. 

Seventh day. — The pressure has been continued, but even -two grains of 
opium gave the man but little rest at night; he feels very unwell, and is rather 
feverish. Two grains of morphia to be taken in the evening. 

Eighth day. — Much better ; has rested last night, but still complains of pain 
when the inner part of the knee and to some short distance above it is manipu- 
lated ; the pressure has been admirably kept up, and the cure appears to be 
rapidly taking place. 

Tenth day. — Going on very nicely. The patient screwed up the clamp 
rather too tightly last night, and having fallen asleep, the pain from the pres- 
sure caused him to dream about it. He felt as if a number of women were 
tearing the flesh from the bones about the knee, and so extreme was the pain 



1854.] 



Siuyeri/. 



245 



that he screamed out lustily ; but after loosening the apparatus he was soon 
composed. The sac is certainly becoming denser; the pulsations are a little 
more reduced in force, but the thrilling sensations to the fingers and the ten- 
derness about the knee still continue. General health good. 

Twentieth day. — On the night of the fourteenth day, the patient neglected to 
adjust the pressure properly ; the blood passed uncontrolled through the vessel, 
and the next day the pulsations were as forcible as on the first day of admis- 
sion ; the sac, however, was still tolerably firm. Since that time he has paid 
more attention to the apparatus. On the twentieth day the pulsations were 
much more subdued, and the sac firmer, so that on the whole the patient is 
going on well again. The enlargement of the articular branches of the artery, 
both on the inner and outer side of the joint, has been very obvious since the 
tenth day : even then the branch on the right side could be clearly and dis- 
tinctly felt. 

Twenty-seventh day. — During the past week things have gone on in the 
same way, the aneurismal tumour being now in the same condition as on the 
twentieth day. On the twenty-sixth day the patient was attacked with a little 
bilious derangement, which was controlled by calomel, opium, and a saline 
purgative ; this produced rather excessive purging, for which chalk mixture 
and laudanum were taken. 

Thirty-fourth day. — During the past week, matters have been going on in 
the same manner; little advance has been made ; the tumour still pulsates but 
feebly, and it is harder; the leg is free from that continual pain which the 
patient originally experienced, although there is now an occasional temporary 
numbness and sometimes a darting pain in the thigh. This pain is probably 
the efi"ect of the pressure ; the patient has regained his ordinary state of health. 

Forty-first day. — Much the same ; the tumour is still pulsating ; the integu- 
ments are slightly denuded, and the parts subjected to pressure are very tender 
and painful; the groin is sore. The oxide of zinc was ordered to be assidu- 
ously applied, and the points of pressure to be varied. General health good. 

Forty-fifth day. — Much the same. 

Fifty-seventh day. — Pulsation has not yet ceased ; the tumour has become 
much firmer, and is a great deal smaller; it has not progressed so well as it 
would have done if the patient during the last week had been as attentive to it 
as he should have been. 

Eighty-first day. — The tumour is much the same as stated in the last report. 
It cannot be diminished by pressure ; it is firm and smooth, but pulsates 
strongly ; the parts subjected to the compression of the instruments are still 
very tender. 

Ninetieth day. — On the night of the eighty-eighth day, and part of the 
eighty-ninth, some gentlemen sat up, that the pressure might be continuously 
kept up night and day; this has produced some good efi'ect, but the pulsations 
still continue. 

Hundred-and-second day. — The swelling is certainly less, but tHe pulsations 
are strong, though they vary much as to their force : two or three days ago 
they had nearly ceased. The same apparatus is employed; groin still tender 
and sore from pressure ; a plaster was applied to it. The general health con- 
tinues good. 

Jan. 14, 1854. (Eighteen weeks after admission.) — The tumour is still pul- 
sating to a small extent, though not constantly, for at times it will cease for a 
few hours. The patient's health continues very good, the limb is free from 
pain, though somewhat swollen about the knee, and a few veins may be seen 
meandering about the joint. For the last week the pressure (by the same 
apparatus] has been made upon tJie lower third of the thigh instead of the 
upper, but no very obvious improvement has been yet observed from this 
proceeding. 

April 4, 1854. (Twenty-ninth week after the beginning of the treatment by 
compression.) — Pressure is still kept up in the lower third of the thigh. Since 
last report, the patient has continued to make slow but sure progress. Mr. 
Hilton, yesterday, applied around the knee, and over the tumour, a bandage, 
and a tourniquet was kept on the artery for five days after the application of 



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[July 



the roller. The pressure of the tourniquet was gradually diminished until 
taken away altogether, whilst, at the same time, the bandage was daily more 
tightened. Pulsation in the tumour has much decreased before the tourniquet 
was taken off ; but this result was considerably assisted by the bandage. 

On April 22 (thirty-first week), the patient was ordered to move about; and,, 
on May 2, compression having been continued for eight months, he was con- 
sidered well-enough to be discharged with caution ; the bandage still applied, 
though with a moderate degree of pressure. The artery may be said to be 
almost in its normal condition, with the exception of slight induration. — Lan- 
eet, May 27, 1854. 

39. New Mode of treating Ulcers from Irritation of the Nails. — Mr. Ure made 
some observations on this subject before the Harveian Society (March 2, 1854). 
He referred to the case of a young woman, aged twenty-three, who had been 
under his care in St. Mary's Hospital. Four months before her entrance, the 
great toe of the right foot became uneasy and swollen, the patient having 
pared the nail the day preceding. Ere long, a nainful and irritable sore made 
its appearance by the side of the nail, which discharged from time to time a 
quantity of thick, bloody, and sometimes black-looking matter. She was thus 
disabled from going about and earning her livelihood. For four years antece- 
dent, she had been in indifferent health, and had suffered from excessive flow 
of the catamenia. She had procured the advice of some respectable practition- 
ers, and been under treatment during several weeks, without, however, obtain- 
ing any benefit. As the sore was rather in an inflamed state on her admission, 
poultices were applied. On the third day, when all surrounding inflammation 
seemed to have subsided, Mr. Ure prescribed the use of a salve composed of 
one grain of finely levigated arsenious acid, incorporated with an ounce of 
spermaceti ointment. He was led to try this remedy by the suggestion of Mr. 
Copeland, who deemed it almost a specific in ulcers of this nature. This was 
steadily employed for about ten days, without producing any marked change 
on the sore. Mr. Ure then ordered, instead, the continuous application of a 
hot saturated solution of alum. This induced rapid absorption of the thick- 
ened parts, and prompt cicatrization of the ulcerated surface, so that the patient 
was enabled to leave the hospital, cured, in the course of three days. Mr. Ure 
observed that, while alum is soluble in five parts of water at 60° Fahr., it is 
soluble in little more than its own weight of water at the boiling temperature. 
A hot saturated solution is, consequently, more energetic in its action than a 
cold one. He had been led to resort to its use in the above instance, from 
having witnessed its efficacy in an analogous case. A gentleman consulted 
him (Mr. Ure) in the autumn of 1852, concerning a sore seated by the side of 
the nail of the great toe, which had annoyed him for nearly a year. A variety 
of treatment had been exhausted in vain attempts at cure, including the plan 
proposed by^Sir A. Cooper, of paring the nail as thin as possible, raising the 
edge, and inserting a small piece of lint between it and the sore ; the free ap- 
plication of lunar caustic, as recommended by Mr. Wardrop ; and also blister- 
ing the part. By the constant application of a saturated solution of alum, as 
hot as could be borne, this refractory sore was eventually healed in a few 
days. 

40. Gunshot Wound inflicted by the Minie Rifle, — Mr. Tufnell communicated 
to the Surgical Society of Ireland (March 11, 1854), the particulars of a case, 
which, he said, was at present of rare occurrence, but one he feared that was 
likely before long to become very common indeed. Its rarity just now, how- 
ever, must make it interesting to the surgical profession, and for that reason 
he was induced to bring it under the notice of the Surgical Society. 

The cast, which lay on tlie table, was taken from the foot of a boy, aetat. 16, 
who was accidentally wounded by a shot from a Minie rifle, while the troops 
were practising at the Pigeon House, on the 25th of July last, and admitted 
into the City of Dublin Hospital the same day. The case was useful in show- 
ing the great difference between a wound inflicted by a conical piece of lead, 
as propelled from a Minie rifle, and the round bullet fired from a musket. The 



1854.] 



Surgery. 



24T 



nature of the injury vras represented by the cast before the Society. There was 
a small semilunar split in the integument on the dorsum of the foot, situated 
over the centre of the metatarsal bone of the little toe, about a quarter of an inch 
in length, giving an appearance as if the ball had glanced across it, and super- 
ficially cut the skin. There was none of the appearance of a gunshot wound, 
there was no contusion, nor were the edges inverted. The ball passed down- 
wards, fracturing the fourth metatarsal bone, and lodging itself deeply in the 
sole of the foot, yet leaving no trace of its passage beyond the most trifling slit 
in the skin, and that so oblique that a probe would not follow the track. It was 
impossible to discover the position of the ball on admission, and for seven or 
eight days from the receipt of the injury, no inflammatory action followed. 
The boy then got out of bed, and walked upon the wounded foot, the conse- 
quence of which was that inflammation commenced in the part, and tumefac- 
tion of the sole followed. lie (Mr, Tufnell) then cut down through the centre 
of the foot and removed the ball, which was lying on its long axis close up 
under the metatarsal bone of the great toe. This ball weighed twelve drachms, 
the weight of the ordinary musket-ball being only eight drachms, making a 
dilference between them of half an ounce. As to the fracturing of the fourth 
metatarsal bone in this case, there was no doubt about it, for he now exhibited 
a portion of the metatarsal bone which he extracted along with the ball. If the 
members present would take the trouble to examine the two balls before them, 
one of which had been fired and the other not, they would perceive a vast dif- 
ference' in them. The hollow iron cup in the one unfired, lay barely on a level 
with the base of the cone, whilst in the one which had been fired it was sunk 
deeply into the lead. This -eup acted as a kind of wedge, and drove it more 
forcibly on. He found that the charge of gunpowder employed to propel a bail 
of twelve drachms from a Minie rifle was seventy-five grains; whereas in the 
ordinary musket, seventy grains were used for a ball of only eight drachms. On 
examining samples of the gunpowder employed, however, he found there was 
a great difference between them. That used for the Minie rifle was much harder 
and more highly glazed than the other, and being, therefore, a much finer de- 
scription of powder, a smaller charge would perhaps be required than of the 
ordinary powder. The weapon now supplying to the army was a very superior 
arm to the musket. A soldier with it can fire with the greatest precision at six 
hundred yards, whilst with the ordinary musket he could not shoot with pre- 
cision at more than two hundred yards. A man supplied with a Minie rifle, had 
therefore an immense advantage over one armed only with the common mus- 
ket, and there was every reason to anticipate that the injuries inflicted by the 
former would be more severe and dangerous than those caused by the latter. 
He did not imagine that a shot from a Minie rifle would make a revolution round 
the body, as happened so often with the old musket-ball. His impression was, 
that if a Minie shot struck with force against the cartilage of the ribs, it would 
go directly through the body and transfix a man like an arrow, instead of pass- 
ing round and escaping behind at the back. No later than that day, he saw a 
ease illustrative of the latter, which was produced in the following manner: A 
deserter, observing that the escort in charge of him were drunk, attempted to 
escape. Two or three of the soldiers pursued and caught him ; one man very 
drunk run up, and although the others held him securely, fired his musket into 
him ; the ball struck upon a rib, ran round to the spine, and got exit there. That 
man would probably recover; but if it had been a Minie ball that was fired at 
him, he would assuredly have been killed. — Dublin Medical Press, March 
29, 1854. 

41. DisJocaiion of hoth Femora at the same time in the same Subject. — H. L. 
Prichard, Esq., relates [Assoc. Med. Joimi. April 21, 1854) the following ex- 
ample of this accident:—- 

" Thomas Phillips, aged 15, a railway wagoner at the Cwmavon works, on 
the evening of the 25th of March, while in a stooping posture in the act of turn- 
ing the switch, was overtaken and knocked down by a truck running with some 
velocity down an inclined plane. He escaped the wheels; but the b«dy of the 



248 



Progress of the Medical Sciences. 



[July 



carriage, which was ten inches only from the ground, passed over him, and, as 
he described it, ' doubled him up/ 

" The case presented a remarkable appearance. The knees and toes were 
inverted; the former were closely approximating each other, while the latter 
rather overlapped one another. The head of each femur was distinctly felt 
under the glutasi, on the dorsum of the ilium. 

" The reduction of the right hip was readily effected with the pulleys, in the 
manner recommended by Sir Astley Cooper, with no other preparation than 
that of chloroform, which the patient took con amore. In eight or ten minutes 
the bone passed into its socket with a satisfactory jerk, audible to the bystand- 
ers. The left was immediately afterwards subjected to the treatment in like 
manner, but was not so easily reduced. Extension having been kept up during 
thirty-five minutes, the knee was found to have descended parallel with that on 
the opposite side. The pulleys were relaxed, and the limb simultaneously ro- 
tated, while my colleague, Mr. F. M. Kussell, kept up the transverse extension 
in the usual manner, and the reduction was effected, but without a perceptible 
crack — attributable, I apprehend, to the exhaustion of the muscles from con- 
tinued extension. 

"I presume an accident of this description is very rare. It is the first with 
which I have met; and I do not recollect to have read of such a case.-" 

[An example of the same accident was recorded in our preceding No., p. 412, 
by Dr. T. C. Barker.] 

42. Dislocation upwards arid hacJvwards of the Metatarsal Bone of the Great Toe 
alone. — The following case of this very rare accident was con^municated to the 
Surgical Society of Ireland, Feb. 11, 1854, by Dr. J. 11. Power. 

John Nichols, aged 49, was admitted into Jervis-street Hospital, on the 23d 
of January last ; he had been a passenger in the Australian emigrant ship, 
the Ta^deur, which struck upon the rocks of Lambay on the morning of 
the 21st. 

Whilst the vessel was rolling from side to side after she had struck, he 
watched his opportunity and leaped from the vessel upon a ledge of rock, 
about eighteen or twenty feet from the spot from which he sprang. He felt 
his situation now was one of danger, for he every moment feared, from the 
rolling of the ship, that the masts might perchance strike him whilst lying 
upon the rocks. He therefore crept upon his hands and feet, as well as he 
could, until he had escaped beyond the reach of accident, either from the ship 
or sea. From the place to which he had escaped he was conveyed to a farm- 
house upon the island, and from thence, upon the 23d, he was conveyed by the 
Thames steam vessel to Dublin, and at once conveyed to hospital. 

His escape, however, was not unaccompanied by injury, and that of a very 
severe and painful description. His right foot had sustained the principal 
violence of the leap which he had made, and for this injury he was admitted 
into hospital. 

The foot was greatly swollen, both in the sole and on the dorsum; the gene- 
ral swelling arose chiefly from the effusion of blood and serum. On making 
examination as to the length of the foot, it was evident that there was shorten- 
ing, measuring from the heel to the point of the great toe. This shortening evi- 
dently depended on some altered condition of the bones between the ankle- 
joint and the last phalanx of the great toe. For in this situation the fore 
shortening w^as quite apparent, although the end of the tibia w^as clearly 
situated in its normal position. The hinder extremity of the os calcis also 
occupied its natural relation to the bones of the leg. I was struck with the 
remarkable appearance presented by the sole of the foot. Nothing of the 
ordinary hollow or concavity was here visible ; on the contrary, its place was 
supplied by a well-marked convexity, firm and resisting. When we examined 
the upper surface of the foot, we ascertained a firm and unyielding elevation ; 
and notwithstanding the general tumefaction, it was quite clear that this eleva- 
tion was formed by some bone in a state of luxation. When the sole of the 
foot was next carefully examined, it was found that another firm body sub- 
jected itself in this situation, and was nearly the antipodes to the tumour on 



1854.] 



Surgery. 



249 



the dorsum of the foot. The inner side presented a twisted appearance; the 
great toe seemed as if rotated on its long axis ; its inner margin was turned 
upwards and inwards, and its outer margin in the opposite direction. From 
the point of the toe to the elevation on the dorsum measured four inches and a 
half. 

All the other articulations of the foot appeared to me to be uninjured. I 
came to tlie conclusion that this was an example of that exceedingly rare 
accident — namely, a dislocation of the metatarsal bone of the great toe upwards 
on the dorsum of the foot. 

My colleague, Mr. Stapleton, with whom I had the pleasure of being on 
duty at that time, examined the case most carefully, and fully confirmed the 
conclusion at which I had arrived. We decided on immediate reduction, and 
having ascertained that our patient's great toe terminated in a full and bulbous 
extremity, I determined to avail myself of this advantage, and accordingly 
fastened a narrow and firm piece of calico, in the form of the clove-hitch knot, 
upon the great toe, immediately behind its bulbous termination. This was our 
means of extension. I next caused the leg to be flexed upon the thigh; the 
knee was then fixed by an assistant, whilst another, with both hands, laid 
hold on the leg near the ankle, and so kept it fixed also. Extension was now 
made in the direction of the abnormal axis of the toe — that is, it was drawn 
firmly and steadily downwards and forwards in the first instance. When the 
extension had been kept up for a short time, I placed my right hand, clenched 
firmly, against the resisting bodies, which caused the principal swelling in the 
sole of the foot, whilst I placed the fingers of my left hand firmly upon the 
elevation on the dorsum of the foot. I now directed the gentleman, who had 
charge of the extending medium, to alter suddenly the direction of his force, 
and to pull the toe in the direction upwards and forwards, and whilst this 
manoeuvre was performing, I forcibly pushed upwards my right hand against 
the tarsal bones, whilst with my left I pushed downwards the tarsal end of the 
metatarsal bone of the great toe, and soon had the satisfaction of hearing a 
peculiar friction sound which conveyed the pleasing intelligence to Mr. Sta- 
pleton's sense of touch and hearing, as well as to my own, that the displaced 
bone had been reduced to its ordinary situation. The foot was then placed in 
a suitable position, and the patient is now progressing to our satisfaction. 

Upon the subject of dislocations at the tarso-metatarsal articulations, we find 
the following records. Two cases of dislocation of the metatarsus from the 
tarsus came under the observation of Dupuytren ; the first was a dislocation of 
all the metatarsal bones on the corresponding bones of the tarsus ; the second, a 
dislocation of the metatai'sus on the tarsiis, affecting both feet at once. In Profes- 
sor Smith's admirable treatise on Fractures in the Vicinity of Joints, two 
more cases are recorded ; in the first, the metatarsal bones, along with the inter- 
nal cuneiform, ivere luxated upivards and backwards upon the tarsus; in the 
second case, the second, third, fourth., and fifth metatarsal bones, together with 
the internal cuneiform bone, were dislocated upwards and backwards upon the 
tarsus. In Mr. South's case, there was a luxation of the fourth and fifth meta- 
tarsal bones upioards and backwards upon the cuboid. 

In the 33d number of the Dublin Quarterly Journal of Medical Science, Mr. 
Tufnell has recorded a case of luxation downwards and backwards of the three 
internal metatarsal bones. In the cast which I now exhibit to the Society, we 
have the features of the accident described by my friend Mr. Tufnell. 

From all I can collect as to the nature of these various luxations at the tarso- 
metatarsal line of articulation, I have not been able to discover the record of a 
case precisely similar to that which I have brought before the Society to-night 
— namely, ct dislocation upwards and backioards of the metatarsal bone of the 
great toe alone. — Dublin Medical Press, Feb. 22, 1854. 

43, Radical Cure of Reducible Inguinal Hernia by a New Operation. — Mr. 
Spencer Wells read before the Royal Medical and Chirurgical Society, May 9, 
1854, a paper on this subject. The author commenced by alluding to two cases 
in which he had operated himself, to three others which had fallen under his 
own observation, to nineteen operated on by Professor Sigmond, of Vienna, to 



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[July 



thirty-two by Professor Rothmund, of Munich, and to an indefinite number by 
Professor WUtzer, of Bonn, the inventor of the proceeding, in none of which 
had any fatal result followed, success having been secured in a very hirge pro- 
portion. He remarked upon the prevailing opinion against any operation fur 
the radical cure of reducible hernia, and traced it to the fatal results of danger-, 
ous methods now deservedly exploded, arguing that, if any plan could be shown 
to be both safe and effectual, the judgment of the profession should be modified. 
After some observations on different means of effecting a radical cure, he de- 
scribed that of Wutzer, and exhibited the instrument used by this surgeon. It 
consists of a wooden cylinder, a needle passing through it, an outer wooden 
cover, and a screw to bind the cover and cylinder together. The mode of em- 
ploying it was then described. After pushing a part of the skin of the scrotum 
before the forefinger, the cylinder takes the place of the finger, the needle is 
passed through it, through the sac and integuments, and serves, with the screw, 
to fix and bind the cover and cylinder together, so that the invaginated skin, 
the walls of the sac, and the abdominal integuments are pressed together, with 
any degree of force that may appear safe or desirable. The instrument is left 
in situ for six or eight da3^s, with the effect of producing adhesion of the whole 
of the sac, a firm organic plug filling the inguinal canal. Very little pain is 
said to be produced. The patient is confined to a sofa until the needle punc- 
ture is healed, and wears a truss for three months afterwards to avoid the danger 
of breaking up of the new adhesions. Mr. Wells then went on to show that 
there were grounds for admitting this operation within the province of legiti- 
mate surgery, and that the classes of cases in which it should be performed 
w^ere — first, in strong persons up to 40 or 45 years of age, where the hernia is 
of a moderate size. In such persons, a perfect cure may be expected. Secondlj^ 
in cases where the hernial protrusion is so large that it cannot be kept up by 
any mechanical contrivance. Here a radical cure is not to be hoped for, but the 
evil is so much diminished that a truss can be made to keep up the hernia effi- 
ciently. He concluded by expressing his belief that, as by this method the whole 
of the inguinal canal can be permanently closed, it is far superior to all others, 
and that the evidence he had adduced of its safety and success should lead to 
its further adoption in this country. 

Mr. Holmes Coote asked whether M. Jobert de Lamballe had not injected 
into the hernial sac some pure tincture of iodine, Avhich had produced exuda- 
tion of a mass of lymph occupying the whole of the sac, and extending up the 
inguinal canal. He believed it had been stated, in some of the foreign journals, 
that such a plan had been adopted, and had resulted in a permanent cure. 

The president said, it would be interesting to know the comparative safety of 
this proceeding and that just recommended by Mr. Spencer Wells. 

Mr. Arnott asked if he perfectly understood the principle on which the new 
instrument acted? It appeared that a small piece of wood was introduced into 
the inguinal canal, pushing a portion of the scrotum before it, and that, by 
means of a needle carried through the piece of wood, the whole was stitched 
together for a time. Observations could hardly at present be made upon the 
mode of proceeding recommended by Mr. Wells, as it was one of which, as yet, 
they had no experience. There was certainly some evidence in its favour, and 
the number of cases which had been adduced that had not been attended with 
any risk, showed that the operation might be performed in the way suggested 
without much chance of mischief. Some of the persons who had been men- 
tioned as having performed the operation were well known to himself; one 
especially, in whose testimony he should have great faith, if a sufficient time 
had elapsed since his operations, was Dr. Sigmund, one of the surgeons at the 
large hospital at Vienna. It was stated that he had had nineteen cases of the 
kind, fifteen of which were successful. It was not, however, stated, how long 
the cases were observed after the operation. He should like to hear from Mr. 
Wells, what was the condition of the parts after a year or two; whether the 
portion of skin which w%as invaginated remained in the inguinal canal, or 
came down; and also what length of time had elapsed between the operation 
and the supposed permanent cure of the patient. The principle of introducing 



1854.] 



Surgery. 



251 



a portion of skin into the canal, and stitching the parts together was not 
new, but the particular method described no doubt was so. 

Mr. Wells said, that Mr. Arnott's description of the action of the instrument 
was perfectly correct. A cylinder was introduced in the place of the finger; a 
cover was placed over it, and it was kept in the proper position by the needle 
which was passed through the skin and sac ; the two were then screwed together, 
and left in that position seven or eight days. Professor Sigmund had told him 
(Mr. Wells) that he had examineji a case six years after the operation. The 
first cases of Professor Wiitzer were in 1837; and last year some of these were 
under his observation, and had remained perfectly cured. He (Mr. Wells) had 
seen his own cases lately — one of them he operated on in 1848, and the other 
in 1850. Both patients remained perfectly sound, although they took very active 
exercise. With regard to the state of the parts, the plug, in the course of time, 
nearly disappeared ; indeed, after five or six years one could scarcely tell that 
an operation had been performed. Five or six months after the operation, a 
round hard plug might be felt in the canal, but it gradually became absorbed. 
He (Mr. Wells) concluded that the adhesion was perfect, as no relapse took 
place. He believed that M. Jobert de Lamballe had injected iodine into the 
hernial sac with success, but only in a single case. Many cases, however, were 
on record in which the injection of various stimulating fluids had led to fatal 
peritonitis, and that, he believed, was one reason why all operations for the 
radical cure of hernia had fallen into discredit. — Med. Times and Gaz. May 
20, 1854. 

44. Abnormal Obturator Aj^tery in Femoral Hernia. — Mr. Mackenzie showed 
to the Medico-Chirurgical Society of Edinburgh (February 1, 1854). a dissection 
of a sac of femoral hernia, in which the abnormal obturator artery had encircled 
the neck of the hernia, and in which he had had the good fortune to operate 
without wounding the vessel. 

The patient Avas a female ; the hernia, of the size of a hen's egg, had been 
strangulated for two days before she was admitted into the hospital. The sac 
was opened in the operation, and the stricture, in Gimbernat's ligament, divided 
as usual. A slight flow of venous blood took place on the stricture being divided. 
The bowel was very dark, but not gangrenous, and was returned into the abdo- 
men. The symptoms were quite relieved, and the wound healed rapidly. On 
the eleventh day after the operation, however, a little fecal matter began to ooze 
through a small part of the wound, which remained unclosed; a preternatural 
anus was established. After a time the feculent discharge began to diminish 
in quantity, and for some time there seemed to be every prospect of recovery, 
when pulmonary symptoms appeared, and she died from phthisis six months 
after the performance of the operation. 

The parts were removed for dissection. The peritoneal sac of the hernia 
formed the walls of the preternatural anus, and the obturator artery, with an 
accompanying vein, was found closely united to the edge of Gimbernat's liga- 
ment on the inner side of the neck of the sac. The obturator artery arose in a 
trunk, about half an inch in length, common to it and the epigastric, from the 
external iliac artery, and had been pushed, by the descent of the hernia, to the 
pubic side of the neck of the tumour. 

It had been a disputed point among anatomists how far the common variety 
of the origin of the obturator artery endangered the vessel in the operation for 
femoral hernia ; but it was generally admitted that the descent of the hernia 
between the femoral vein and the abnormal artery (as in this instance) was 
very rare. 

Cases had been recorded vs^here fatal hemorrhage had occurred in the opera- 
tion, apparently from this variety of the artery, but Mr. M. was not aware of 
any case having been recorded in which this variety had existed, and in which 
the vessel (as in the present case) had escaped being wounded in the operation. 

The fortunate operation was of course mainly attributable to accident ; but 
he had used the precaution, Avhich he had always adopted in operating for 
femoral hernia, of introducing no more than the point of the knife within the 
stricture, and of using a slightly blunted cutting edge for the division of the 



252 



Progress of the Medical Sciences. 



[July 



stricture — a precaution which had been long ago recommended with a view of 
avoiding the accident in question. — Monthly Journal of Medical Science, March, 
1854. 

45. Amputation at tlie Shoulder Joint. — Mr, Alexander Ure read a paper on- 
this subject before the Harveian Society, March 16, 1854. He observed that 
amputation at the shoulder-joint may be performed in a variety of ways. M. Lis- 
franc, in his work on Surgery, had described no less than thirty-two different 
modes of doing the operation. Those chiefly resorted to at the present day 
were either the flap operation, or what is termed the oval method. Where the 
patient was of a spare make, and the shoulder of moderate dimensions, the 
oval method answered well ; where, on the other hand, the shoulder was large 
and brawny, the flap operation Avas more eligible. He remarked, that where 
the soft parts were extensively torn and bruised, or the shoulder was misshapen 
by disease, no specific could apply, and the surgeon must be guided by exist- 
ing circumstances. The author, after pointing out the anatomical relations of 
the part, detailed the successive stages of each operation. In reference to the 
formation of the flap, he stated that if the arm be brought into a horizontal 
position, the deltoid muscle can be fully grasped by the hand of the surgeon, 
and lifted up in a relaxed condition, so as to permit of the knife being thrust 
between the muscle and the capsule of the joint. He inculcated the importance 
of leaving the division of the axillary vessels to the last stroke of the knife, and 
said the flow of blood might be completely controlled by simply directing an 
assistant to place his two thumbs on the bleeding face of the stump, while with 
the fingers of each hand he laid hold of the integuments. If the compression 
were skilfully made, one hand would usually suffice. He deprecated every 
method of amputating in this situation, which necessitated mediate ligation. 
The author related the particulars of a case in which he had recourse to the 
oval operation. The patient Avas fifty-five years of age, of rather short stature 
and spare make ; his calling that of a cow-keeper. He was brought into St. 
Mary's Hospital on September 16, 1853, having shortly before been knocked 
down by a heavy-laden wagon, the wheel of which crushed his left arm, pro- 
ducing a compound comminuted fracture of the humxcrus just above its upper 
third. The adjunct soft parts were severely bruised and lacerated; the deltoid 
muscle was partially detached and retracted towards the acromion process of 
the scapula ; there was a penetrating wound through the integuments at the 
site of the fracture by which a probe could be passed nearly up to the neck of 
the bone; the limb below the seat of injury was quite cold ; no pulse could 
be felt at the wrist. When seen by the author about an hour after admission, 
the patient was in rather a prostrate condition ; the countenance anxious ; the 
pulse in the sound arm feeble, tremulous, 108 in the minute: 'the tongue dry, 
and its surface yellowish-brown. After consultation with two of his colleagues, 
the author proceeded at once to remove the arm at the shoulder-joint, the pa- 
tient having been previously rendered insensible by chloroform. A vertical 
incision was made through the skin and subjacent tissues down to the bone, 
commencing at the acromion, and terminating at a point corresponding to the 
fold of the armpit. This was continued by a semicircular sweep through the 
integument of the back of the arm, and brought round so as to join the extre- 
mity of the former cut. The fleshy structures towards the acromial side were 
then carefully dissected, and after cutting across the tendons, and laying open 
the capsule of the joint, the head of the bone was dislocated. The edge of the 
knife was now directed so as to cut its way out, downwards, behind the bone, 
precaution being had to avoid the artery, which at this stage was firmly held 
and compressed by Mr. James Lane. Four vessels were immediately secured 
in the ordinary way. As a quantity of blood continued to well from the axillary 
vein, it was likewise tied. A portion of the bruised flesh having been removed, 
the edges of the wound were brought together, and retained in apposition by 
means of sutures, and a pledget of wet lint applied. During the operation the 
subclavian artery was most efficiently compressed upon the first rib over the 
clavicle by Mr. Lane ; hence the amount of blood lost did not exceed two 
ounces, and that chiefly venous. In reference to ligation of the vein, the 



1854.] 



Surgeri/, 



253 



author observed that it not only served to arrest the bleeding, but also to ob- 
viate the risk of jeopardy froui the ingress of air into a gaping orifice in close 
proximity to the heart. A wound of the axillary vein had already proved fatal 
from this circumstauce. Roux thus lost a patient vrhile amputating at the 
shoulder-joint. There was an anatomical reason why such an accident was 
prone to occur. The axillary vein below the clavicle was so intimatel}'- con- 
nected with the coraco-bracliial fascia, and the perichondrium of the cartilage 
of the first rib, that when incised ,or cut across it was unable to collapse, and 
thus offered every facility for the inlet of air. On examining the amputated 
limb, it was ascertained that the bone was broken right across a little below 
the neck, and again two inches lower down, the intermediate portion being 
shivered lengthwise into four irregular fragments. These sharp pieces were 
deeply buried in the adjunct flesh, which was in a mashy condition both above 
and below. The sheath of the brachial vessels was gorged with blood for 
several inches in length. The artery was apparently entire. The patient, 
after he was placed in bed, was directed to have a dose of laudanum, and every 
third hour half an ounce of brandy. The patient made a good recovery, and 
was removed on the 16th December to the convalescent institution at Car- 
shaUon ; from thence he was discharged quite well in less than a month. In 
some remarks upon the case, the author alluded to the dangers attendant upon 
the attempt to save a limb in such a state from the consequent exhausting pro- 
cesses of sloughing and suppuration, or from the supervention of tetanus. He 
also made some remarks on the importance of the after treatment, chiefly with 
reference to the position of the patient. — Lancet, April 1, 1854. 

46. Ampniafion at the Knee-joint. — By H. G. Potter, Esq., Surgeon to the 
Newcastle Infirmary. — Harriet S , aged forty, was admitted into Newcas- 
tle-upon-Tyne Infirmary on the 8th of December, 1853. She states that about 
twenty years ago she knelt upon a small stone, which gave her great pain in 
the knee. From that time until about six months ago she had severe pain, at 
intervals, in the joint, but w^as not laid up. During the last six months she 
has been confined to bed, and though everything seems to have been tried 
which was likely to do good, the disease increased, and the leg became more 
and more flexed until, as at present, it has reached the utmost uegree possible. 
Any attempt at extension gives intense pain ; some tortuous sinuses run down 
to the bone ; and there is every symptom present which indicates ulceration of 
the cartilages. She is very thin and hectic, and is extremely anxious to have 
the limb removed. 

Operation. Dec. 13. — An incision commencing a little above the middle of 
the external condyle was continued across the knee, round the upper half of 
the patella, to the middle of the inner condyle, and ended a little above it. 
This incision separated the patella from its superior attachments, and opened 
the joint. The ligaments were next divided, and the saw introduced behind 
the condyles, which were with the greatest facility sawn through. I used the 
saw I described in The Lancet of 1845, vol. ii. p. 546, and which will be found 
to be of great use in such operations. The knife was now placed behind the 
joint, and a full-sized flap formed from the back of the leg. No difficulty was 
met with in any part of the operation, and the flaps came nicely together, in 
which position they were retained by sutures and plaster. Chloroform was 
successfully administered by Mr. Gibb, our talented house-surgeon. 

On examining the joint after removal, the cartilages were found to be ulcer- 
ated, and the synovial membrane pulpy. 

Dec. 14. — There is a remarkable change in the countenance this morning. 
From the time she entered the hospital, until to-day, she has had a very hag- 
gard look; now, however, the countenance has assumed a placidity which con- 
trasts very favourably wnth its previous disturbed appearance. The pulse is 
quiet and regular, and she rested well during the night. 

From this time the case went on well, the flaps united by the first intention, 
the patient acquired strength and flesh, and was discharged cured on the 17th 
of xMarch, 1854. 

Should I again perform this operation, I would remove the diseased synovial 
No. LV.— July 1854. 17 



254 



Progress of the Medical Sciences. 



[July 



membrane from the upper flap, because I feel convinced that this diseased 
structure was the cause of a discharge which continued much longer from an 
old sinus than would have been the case had the synovial membrane been 
removed. — Lancet, May 27, 1854. 

47. Excision of tJie Knee-joint. — Mr. R. J. Mackenzie stated to the Medico- 
Chirurgical Society of Edinburgh (March 1, 1854), that he had now performed 
this operation in three cases. The first would be immediately presented to the 
Society, and would speak for itself. Recovery in the second case had, from 
various causes, proved more tedious than it had at first promised to be. The 
patient, however, progressed satisfactorily, though slowly ; and Mr. Mackenzie 
had no fear as to the ultimate result. The limb was becoming rigid at the 
knee, and was straight, shapely, and but moderately shortened. He hoped at 
a future meeting to present this patient, with a sound and serviceable limb. 
In the third (a peculiarly unfavourable case for the operation), the result had 
been fatal. The case was one of acute ulceration of the cartilages, accompa- 
nied by suppuration; the joint being distended with pus. The patient, a lad 
of 18, was in an advanced stage of hectic, emaciated, and much exhausted by 
continued sufi'ering. He was most reluctant to submit to amputation ; and, 
having seen one of the patients walking about, on whom the operation of ex- 
cision of the knee-joint had been performed, he expressed an anxious wish that 
an attempt should be made to save the limb by the performance of this ope- 
ration. It was a matter of regret that this request had been complied with ; 
for, although amputation held out but a small chance of recovery, the case was 
little suited to test the merits of the operation of excision. Immediate and 
great relief followed the operation ; and, as far as the limb was concerned, 
everything had progressed as favourably as could have been wished. Diarrhoea, 
however, which had been threatened before the performance of the operation, 
set in; the tongue and lips became covered with aphthous crusts; he suffered 
from cough and night sweats ; and sank, in the course of a month after the 
operation. The wound was in great part healed, and no difficulty had been 
experienced in keeping the limb in excellent position. Permission could not 
be obtained to examine the body; but Mr. Mackenzie had little doubt that 
tubercular disease of internal organs would have been found. 

Mr. Mackenzie stated that, since the subject had been last brought before 
the attention of the Society, the operation had been performed by several able 
surgeons in England, Scotland, and Ireland. He had written to four of these 
gentlemen, requesting them to furnish him with the result of their experience; 
and he had received from all very kind and full replies to his inquiries. He 
read some extracts from the letters which he had received from Mr, Page of 
Carlisle, Mr. Gore of Bath, Dr, Keith of Aberdeen, and Mr, Butcher of Dublin, 
all of which gave favourable accounts of the cases under their care, and ex- 
pressed themselves as being advocates of the operation. 

A patient (a man between forty and fifty years of age), was then exhibited, 
in whom Mr. Mackenzie had performed the operation of excision of the knee- 
joint a year previously. He appeared to be in robust health, and traversed 
the hall, in various directions, with ease and celerity. In walking, the toes 
were pointed downwards, but, his body yielding slightly, he planted the foot 
firmly on the ground, and rested his entire weight on the limb without uneasi- 
ness. In the horizontal posture, he elevated and depressed it with the greatest 
nicety. On examination, the limb was found slightly curved outwards, firmly 
anchylosed at the knee, three quarters of an inch shorter than its fellow, and 
■equal in muscular development. The heel of the shoe was raised inside three- 
fourths of an inch, to allow for the shortening. lie. stated that he had been 
walking for six months. 

Mr. Syme said, that the question was not as to the possibility of saving the 
limb, but how far excision of the knee-joint could be substituted for amputation 
of the thigh, and an useful limb preserved. Now, all subsequent experience 
went to show tha.t the operation was not a good one, and that it could not with 
advantage he substituted for amputation, even admitting the possibility of 
keeping on the limb. He questioned the usefulness of the limb in the case 



1854.] 



Surgery. 



255 



shown to the Society. The future must be looked to ; and much depended on 
the avocations of the patient. Should they be rough and laborious, the limb 
would speedily be affected with swellings or ulcerations, and amputation would 
become necessary. Again, how many times have the limbs been lost, or un- 
satisfactory results obtained? The question was not Mr. Mackenzie's skill as 
an operator ; but how far we could regard this operation as a boon to the 
human race. 

Mr. Mackenzie was sorry to hear the statements of Mr. Syme, which he could 
not but regard as the results of mere theory, and not deduced from a fair con- 
sideration of the facts which had been brought forward. He would only refer 
to the opinions of some of the best surgeons in the country, whose recent ex- 
perience of the operation bore ample testimony to its value, as shown in the 
letters which he had read to the Society. Mr. Syme had spoken of the great 
loss of life following the operation. In this Mr. Syme was mistaken; of the 
last fifteen cases in which the operation had been performed, three cases only 
had terminated fatally ; a proportion which would surely bear comparison 
with the operation which Mr. Syme recommended, amputation of the thigh. 
Mr. Syme, too, spoke of the useless limbs which were preserved. He would 
refer to the patient whom they had just seen, and M^ould leave the Society to 
judge whether his limb were useless; he would refer to such cases as that of 
Mr. Page, where the patient was standing or moving about at his employment 
the whole day, sometimes walked six or seven miles to the country for his 
amusement, and could walk with any of his companions. He would refer, 
indeed, to the gratifying results in this respect of nearly every case in which 
the operation had been perforfned of late years. With scarcely an exception, 
the operation had been the means of saving a truly serviceable limb. 

Mr. Syme did not expect to change Mr. Mackenzie's opinions. The object 
of his remarks was to state his own; and a little time would show which were 
correct. He might be wrong in the conclusions to which he had come; but he 
begged to adhere to them. — Monthly Journ. Med. Sci. May, 1854. 

48. Dieffenbach's Operation for Ummited Fracture. — Mr. Mackenzie exhibited 
to the Medico-Chirurgical Society of Edinburgh (February 1, 1854), a thigh-bone 
on which he had practised Dieffenbach's operation for the cure of ununited 
fracture, the drilling of the ends of the bone and the insertion of an ivory peg. 

The patient, a seaman, had fractured his thigh between two and three years 
before he was admitted into the hospital under Mr. M.'s care. He was treated 
in a public hospital in America, and he attributed the want of union to the limb 
not having been kept steady, the bandages confining the limb having been loosely 
applied. 

The fracture was in the middle of the bone, and the lower fragment was re- 
tracted about an inch and a half on the inner side, and behind the upper. The 
limb was quite flexible at the seat of fracture, and was almost entirely useless 
as a means of support. 

The ends of the bone were drilled with a small gouge worked by a carpenter's 
brace, and a peg, two and a half inches in length, was driven home with a ham- 
mer. The presence of the foreign body gave rise to such extensive inflamma- 
tion and constitutional disturbance, that it was found necessary to remove it at 
the end of eight days. Profuse suppuration took place, undermining the whole 
deep textures of the thigh, and it seemed doubtful for some time whether the 
patient was not to sink from the effects of the operation. He rallied, however, 
and the suppuration gradually diminished. Firm osseous union took place, 
and at the end of some months the patient began to make use of the limb in 
walking. A sinus, however, continued to discharge matter at the seat of 
operation ; and, after he had been walking for some weeks, he suffered from 
an attack of erythema of the limb; suppuration of the knee-joint followed, ac- 
companied by hectic fever, and amputation was performed immediately above 
the seat of fracture. 

The preparation showed the fractured ends firmly united by a large osseous 
deposit. 

Mr. Mackenzie believed this was the only case in which Dieffenbach's method 



256 



Progress of the Medical Sciences. 



had been practised in Edinburgh. The result was not encouraging as regarded 
its further trial, at least in the thigh. A considerable amount of success had 
followed the practice, in ununited fractures of the leg and forearm, in the hands 
of the London hospital surgeons ; but the only other case in which, as far as 
he could find, it had been attempted in the thigh, had proved equally unfortu- 
nate ; he alluded to a case by Mr. Square, of Plymouth, in which, as in the 
present case, it had been subsequently found necessary to perform amputation. 
—Monthly Journal of Medical Science, March, 1854. 

49. Puncture of the Bladder through the Symphysis Pubis, — In our No. for 
April last (p. 403), will be found recorded a case in which this operation was 
performed by Dr. D. Leasure of New Castle, Pennsylvania. At a recent meet- 
ing of the Medical Society of London, we find (see Lancet, April 15, 1854), 
that a paper entitled "A new method of puncturing the bladder by Dr. 
Brandes, of Jersey, was read. This new method is the one practised by Dr. 
Leasure. Dr. Brandes states that the practicability of this operation may be 
readily proved by any one who chooses to try the experiment upon the dead 
body, and appeals to the successful results of 100 instances in which he him- 
self has operated on the dead subject. In these experiments, whether per- 
formed with the bladder empty or distended, he had never once failed in 
causing the instrument to enter that organ. The mode of operating is ex- 
tremely simple. "The patient should be placed erect, resting against a wall; 
a longitudinal incision, about one inch in length, is then to be made in the 
integument immediately covering the symphysis pubis. A hydrocele trocar is 
then to be introduced at its upper third, and directed somewhat obliquely 
downwards and backwards towards the sacrum, varying the direction accord- 
ing to circumstances. A piece of flexible catheter is then to be introduced 
through the canula of the trocar, which, being retained in situ by a tape passed 
round the hips, completes the operation." Mr. Hancock stated that the chief 
objections which he had heard urged against the operation were, the risk of 
infiltration of urine into the cellular tissue occupying the space between the 
pubes, bladder, and neighbouring parts; the difficulties likely to attend the 
healing of a wound in a cartilaginous substance, and the possibility of the 
inflammation at the symphysis being communicated to the peritoneum. The 
advantages of this over the other operations for puncture of the bladder were 
considered to be — the ease with which that viscus might be reached, in conse- 
quence of its fixed position in this situation, although it or the parts in its 
neighbourhood might be diseased ; ths absence of danger of wounding any im- 
portant structures, especially the peritoneum; its better adaptation to cases of 
contracted bladder, whether from age or any other cause, in corpulent per- 
sons; in displacements of the bladder, whether congenital or the result of 
injuries sustained in the perinaeum or pelvis, or as results of pregnancy, retro- 
version of the uterus, obliteration of the meatus urinarius by disease, preter- 
natural descent of intestines, &c. ; that it is less painful, and is more expedi- 
tiously performed than the other operations; that the wound being smaller, 
the source of irritation would be less, a point of much importance where irri- 
tation and fever already exist in the system; the catheter being more fixed is 
less likely to escape from the contraction of the coats of the bladder, or, on the 
contrary, to slip into the bladder, an accident which has been known to occur 
where puncture above the pubes has been had recourse to. It can, likewise, 
be more readily replaced when its withdrawal has been necessary. It is eli- 
gible, in certain cases, in which puncture of the rectum or urethra are inad- 
missible on account of altered states of the parts. The readiness with which 
the patient may be placed in a position suitable for the draining away of the 
urine, in which respect it is greatly superior to the supra-pubic operation. Its 
applicability in cases of retention of urine arising from inflammation in the 
bladder itself, where that viscus becomes too irritable to admit of the accumu- 
lation of the urine to the extent even of a few ounces without extremely urgent 
symptoms of retention supervening, remaining, of course, at the same time, in 
an undistended condition, a state which would render the supra-pubic opera- 
tion ineligible. The author, moreover, announces that since his paper was 



1854.] 



Surgery. 



257 



written in the year 1838, the operation has been successfully performed on 
several living subjects by himself and others, without any of the ill conse- 
quences apprehended by some theorists. Cases are related in the Medical 
Transactions, &c., Bengal, vol. viii. part 2. 

50. Ovariotomy, with reference to its Introduction into Legitimate Practice. — 
[Mr. G. B, Childs lately read a paper on this subject before the Medical Society 
of London, an analysis of which, ^yith the report of the discussion which took 
place, we give in order to show the opinions entertained in London in regard 
to this operation.] 

Since the end of the last and the commencement of the present century — the 
era marked by the labours of Hunter and Baillie — the numerous diseases 
classed under the vague term of female complaints have received much atten- 
tion, and have been better understood, principally through the more frequent 
employment of improved philosophical instruments, and also through more 
minute and extended inquiries into the phenomena of disease. In these inves- 
tigations the diseases of the ovaries seem to have attracted the notice of British 
earlier than of Continental medical men. Three operations had been proposed 
for ovarian diseases — viz., puncture, excision, and extirpation. The operation 
of puncture was scarcely better than leaving the patient without any treat- 
ment, for the records of 170 cases collected by Dr. Robert Lee proved that the 
disease seldom remains quiescent under no treatment, while it is seldom cured 
and scarcely ever relieved by tapping. The author would not, however, follow 
the opinion of those who ascribed death to this operation, for the fatal result 
could no more be attributed to- it in this case than in ascites. The operation 
of excision, as well as those by injection and the seton, were shown to have 
arisen from the discovery that so-called ovarian diseases were often accompa- 
nied with hydatids or cysts, by steatomatous or sarcomatous growths, and that 
sometimes even malignant growths were present. Le Drau endeavoured to 
destroy the morbid cyst by injection and wadding; Chopart and Desault 
opened the sac or sacs with caustic ; Dzondi laid open the sac and attempted 
to remove it by forceps ; and at last De la Porte and Morand proposed extir- 
pation, which was performed by L'Aumorier in 1782. Mr. Childs then noticed 
the operation of Mr. I. B. Brown, and referred to the complications often dis- 
covered during the operation for excision. Proceeding then to speak of ovari- 
otomy, he disapproved of the usual practice of delaying the operation, alleging 
that delay can produce no benefit to the patient, and that it will be attended 
with greater probability of the formation of adhesions. The errors in diagnosis 
which have been sometimes committed form no argument against the opera- 
tion. It was a remarkable fact that sterility was a very common accompani- 
ment of ovarian disease ; but it was also true that ovarian tumours were some- 
times found in women who had borne several children. The author adduced 
a short analysis of the cases of ovariotomy, collected by Dr. R. Lee, from which 
it appeared that — 1. The abdomen was laid open in eight cases, in which no 
disease was found ; of these two died. 2. The abdomen was opened in fifty- 
four cases, in which the diseased mass could not be removed; of these there 
died eighteen. 3. The diseased ovary was removed in one hundred patients, 
of whom thirty-eight died. The mortality was not to be considered large when 
it is remembered how common it is to delay the operation. In many of the 
fatal cases, and of those in which the operation could not be performed, it 
would be easy to show that delay had been the principal cause of the failure 
or of the fatal result. Hence the author concluded that to abandon ovariotomy 
in all or even in most cases would neither contribute to the interests of hu- 
manity nor to the honour of surgery. The author concluded his paper with 
the narrative of two cases in which he had performed the operation. The first 
was successful ; in the second, the patient died of diarrhoea. 

Dr. Snow remarked that much uncertainty existed with reference to ovari- 
otomy, from the very unsatisfactory nature of the statistics of the operation. 
The successful cases were usually published, but many unsuccessful ones, he 
believed, never met the light. He did not insinuate that cases were withheld 
because they were unsuccessful ; but many gentlemen who performed the 



258 



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[July 



operation were not in the habit of laying their cases before the Societies, or 
publishing them in the journals. His (Dr. Snow's) own experience, which 
extended only to four cases, at which he had been present, was one recovery 
and three deaths. He did not think that the comparison between this opera- 
tion and amputation could be sustained ; there was no analogy between the 
cases requiring the proceeding. In cases which required amputation the 
patient might be unable to exist without its performance ; but this was not 
essentially the case in ovarian dropsy, particularly in the early stage, at which 
Mr. Childs recommended interference; for then the general health of the 
patient might be good, and there might be no reason why he should not live 
for a number of years. It would in such a case be scarcely justifiable to ope- 
rate with the imminent risk of death ensuing in three days, and in cases per- 
formed late the result was generally fatal. 

Dr. Winn considered that the paper of Mr. Childs had placed the whole 
question in a clearer light than it had been before presented; but still thought 
we were yet unable to arrive at a satisfactory opinion regarding the value of 
the operation, from want of information on some important points connected 
with it. He believed that the danger to be apprehended from wounds of the 
peritoneum had been much overrated. He could not, however, recommend a 
very early interference in these cases, from observing how Nature occasionally 
interposed to arrest the disease. He had lately seen one case in which the 
patient had improved much after the disease had existed for many years. Dr. 
Ashwell had recently recorded in The Lancet some cases of fibrous tumours 
of the uterus which had disappeared spontaneously. 

Mr. Gay remarked on the more frequent performance of ovariotomy since 
the introduction of chloroform. No doubt the proceeding was successful in 
many cases, but he agreed with Dr. Snow that our statistics on the subject 
were valueless. It had been stated that the average duration of life in per- 
sons affected with ovarian dropsy was three or four years : if you could prolong 
this period by operation, then a boon was conferred by its performance. But 
we had no evidence before us to show that this was the case. It was desir- 
able, however, to determine which were the cases likely to be benefited by 
operation. The first case recorded by Mr. Childs he (Mr. Gay) considered 
favourable to the proceeding; but he had doubts as to the propriety of the 
operation in the second case, from the circumstance of some ascites being pre- 
sent, fluid being detectable in the cavity of the peritoneum. 

Mr. I. B. Brown said that hitherto the statistics of the operation had been 
so imperfect that no conclusion could be drawn from them. Individual expe- 
rience, he thought, must decide the question as to whether or not this opera- 
tion was a justifiable one. Having tried most of the plans which had been 
suggested for the cure of ovarian dropsy, with the exception of that recom- 
mended by Dr. Tilt, and that of injecting the emptied sac with iodine, he had 
come to the conclusion that ovariotomy was a justifiable operation in certain 
cases. He thought that recoveries from that procedure would become more 
numerous as our knowledge respecting the disease improved. The diagnosis 
was no doubt a difiScult one in some instances, and much neglected by clinical 
teachers. He looked for a better state of things. One of the most important 
points in the diagnosis was to determine whether the disease was a merely 
local one, or connected with such a contamination of the blood as to render it 
malignant. In the second case recorded by Mr. Childs, he augured badly of 
the operation from the appearance of the patient, which was that of a person 
affected with malignant disease ; but, under all the circumstances of the case, 
•he had considered the operation quite justifiable. He agreed with Mr. Childs 
on the importance of not delaying the operation until the patient was in an 
exhausted state. In fatal cases after operation, he had usually found the kid- 
neys to be diseased. It augured well for the operation that Mr. Fergusson, at 
one time so warmly opposed to it, should, in the last edition of his Practical 
Surgery, have observed, that in "well-selected cases it was a proceeding to 
be recommended. 

Dr. Murphy, after making some remarks on the fallacy occasionally follow- 
ing data drawn from statistics,, considered that correct knowledge of the disease 



1854.] 



Surgery. 



259 



and operation under consideration must be derived from the careful study of 
individual cases. In illustration of this, he related three cases. The first was 
that of an old lady, sixty-five years of age, who sufi"ered from an ovarian 
tumour, which was partly solid and partly fluid. The risks of the operation 
were explained to her, and she consented to its performance. Mr. Erichsen 
accordingly removed the tumour, and the patient got quite well. In opposition 
again to this, a case had come under his (Dr. Murphy's) care, of a young lady, 
aged eighteen, who sufiered from an ovarian cyst of a simple character. lie 
put her under treatment by pressure, after drawing off the fluid, and she got 
quite well, no return of the fluid being perceptible at the end of six months. 
In a third case, the adhesions appeared to be so firm that operative procedure 
seemed to be hopeless. In this case, however, the tumour burst into the 
vagina, and had since gradually disappeared. He regarded the operation of 
ovariotomy as more analogous to that for aneurism than amputation, in the 
former of which the patient might at any time die suddenly from the disease, 
and a dangerous operation only could save the patient. 

Mr. PiLCHER could not regard the second case mentioned by Dr. Murphy as 
perfectly cured ; sufficient time had not yet elapsed to enable us to form an 
opinion upon this point. The statistics of the operation were most unsatis- 
factory; for even those cases recorded as successful, he feared in too many 
instances were the reverse. In the practice of a gentleman eminent fur this 
operation, he (3Ir. Pilcher) had heard of three cases which had been regarded 
as successful, but which had proved fatal from the eftects of the operation. In 
one case, a lady had enjoyed life for two years after the operation, but died at 
the end of that time from chri:)nic abscess occurring in the base of the broad 
ligament. In a second case, a lady married after the operation, but died sud- 
denly from causes traceable to the operation. In the third case, no reason had 
been assigned for the death, but it was fair to presume that it was not inde- 
pendent of the operation. — Lancet, April 15, 1854. 

51. Treatment of Ovarian Dropsy hy Injections of Iodine into the Cysts. — Pro- 
fessor SiMPSOx read the following paper before the Edinburgh Obstetrical 
Society: — 

It has been often proposed to treat dropsy of the ovary upon the same 
principles as hydrocele or dropsy of the tunica vaginalis. In accordance with 
this view, Drs. Hamilton, Scudamore, and others, have in former times injected 
ovarian cysts with irritating solutions of sulphate of zinc, &c. ; bat the results 
have in general proved so unfortunate and disastrous as to prevent a repetition 
of the practice. 

In 1832, Mr. Martin first recommended the use of tincture of iodine as the 
surest and safest injection for the cure of hydrocele; and this drug seems now 
almost universally adopted by surgeons in the obiiterative treatment of this 
variety of local dropsy in the male subject. 

Latterly, various surgeons, particularly Yelpeau, Bonnet, Belluerimi, &c., 
have extended the prtictiee of iodine injections to the treatment of other local 
dropsies and cysts; to chronic abscesses; diseases of the joints, &c. And the 
past experience of surgeons on the subject would certainly seem to show that 
while the local and direct application of iodine to morbid secreting surfaces 
has a great power of modifying, altering, and arresting even the secretory 
action of these surfaces, and often changes suppurative into adhesive inflamma- 
tion, it shows at the same time wonderfully little aptitude to excite any excess 
of local irritation and pain. Hence naturally arose the question whether it 
could be safely and successfully injected iuto such large cysts as those of the 
common form of dropsical ovary. 

In 1846, Dr. Alison, of Indiana, recorded the history of a chronic case of 
ovarian dropsj'^ that had been repeatedly tapped, and which he injected at last 
with a solution of iodine. Severe symptoms followed, but the ultimate result 
seems to have been favourable. In 1851, Dr. Simpson assisted Mr. Syme in 
injecting a cyst in the neighbourhood of the ovaries, but not a common cystic 
form ovary. The symptoms which ensued were those of considerable excite- 



260 



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[July 



inent; but the original cyst apparently became obliterated. Another one in 
its vicinity has lately shown itself in this patient. 

Within the last year, Dr. Simpson has, subsequently to tapping, injected 
into dropsical ovarian cysts the tincture of iodine in seven or eight cases. For 
this purpose he has employed the common tincture of iodine of the Edinburgh 
Pharmacopoeia, undiluted. He has usually thrown into the cyst two or three 
ounces of the tincture. In some cases he has allowed a portion of the injected 
fluid to re-escape; in others has retained the whole of it in the sac of the cyst 
that was tapped. From these cases he drew the following conclusions : — 

1. In none of the cases of ovarian dropsy treated with iodine injections after 
tapping has he yet seen any considerable amount of local pain follow the in- 
jection with one exception; in most instances no pain at all is felt; and in 
none has constitutional irritation or fever ensued. In the one exceptional case 
considerable local irritation followed, and the pulse rose to 110; but the same 
phenomena occurred in the same patient after previous tappings without iodine 
being used. 

2. While the practice seems thus so far perfectly safe in itself, it has by no 
means proved always as successful as in hydrocele in preventing a reaccumu- 
lation of the dropsical fluid ; for in several instances the effusion into the sac 
seems to have gone on as rapidly as after a simple tapping without iodine 
injection. 

3. But, in two or three of the cases, the iodine injection appears to have 
quite arrested, for the time being, the progress of the disease, and to have pro- 
duced obliteration of the tapped cyst, as there is no sign whatever of any 
reaccumulation, though several months have now elapsed since the date of the 
operation. 

Lastly. Accumulated experience will be required to point out more precisely 
the special varieties of ovarian dropsy most likely to benefit from iodine in- 
jections, the proper times of operating, the quantities of the tincture to be 
injected, and other correlative points. Perhaps the want of success in some 
cases has arisen from an insufScient quantity of iodine being used, and from 
the Avhole interior of the cyst not being touched by it. The greatest advantage 
would of course be expected from it in the rare form of unilocular ovarian 
cysts. In the common compound cyst the largest or most preponderating cyst 
is usually alone opened in paracentesis; and though it were obliterated, it 
would not necessarily prevent some of the other smaller cysts from afterwards 
enlarging and developing into the usual aggravated form of the disease. — 
Monthly Journ. Med. Sci. May, 1854. 

52. Summary of the Statistics of some of the more Important Operations per- 
formed in the principal London Hospitals during the last six months of 1853. — 
Lithotrity v/ould not appear to be in great favour with London surgeons, at least 
not in hospital practice; since, out of 32 patients presenting themselves with 
stone in the bladder, it has been performed in only 4 cases. Of these 4, two 
died and 2 recovered. The recoveries were in men of middle age, and in each 
case, after about two months' treatment and from five to six sittings, the entire 
calculus was considered to have been removed in both instances, and the pa- 
tients, we believe, yet remain without relapse of symptoms. In one of the 
fatal cases, the man was aged 57, and death from cystitis and subsequent pyae- 
mia followed the first operation. In the other, the man was aged 30; cystitis 
had followed the first operation; in the second, the bladder was injured, and 
death resulted a few days afterwards. In both, death was therefore fairly attri- 
butable to the operation. 

Lithotomy has been performed on 28 patients, with the result of 22 recoveries 
and 6 deaths. The risks attendant on this operation vary so greatly with the 
age of the patient, that we may conveniently classify them with regard to that 
circumstance. 

}3oys under fourteen. — 20 of the above 28 cases were boys, and of these 2 only 
died, exclusive of a third, who recovered from the operation but died of thoracic 
disease about two months after, and before he had left the hospital. The cases 
v.'hich died are the two youngest on the list, their ages respectively being six- 



1854.] 



Surgery. 



261 



teen and twenty months. One of them died a few days after the operation, from 
inflammation of the pelvic cellular tissue. Difficulties had attended the attempt 
at extraction, and the calculus had not been removed, since in consequence of 
the staff slipping from its place, the bladder had not been entered. It is worthy 
of note that the fatal event had no connection with the too free incision of the 
prostate, since the latter had only been notched in its anterior margin. The 
second case died without known cause about 48 hours after a successful opera- 
tion. The infant was found to haye granular degeneration of the kidneys, and 
it was believed that the chloroform had exerted an evil influence. 

Above the age of fourteen. — 8 cases, with two exceptions, all adult men, up- 
wards of 50, and one of them aged 71 ; four of them died. A lad aged 18, from 
whom a calculus impacted in the urethra had been removed, died shortly after- 
wards, in consequence of previously existing and very advanced disease of the 
bladder, ureters, and kidneys. A man aged 25, very ill at the time of the ope- 
ration, died on the tenth day from phlebitis and pycX3mia. A man aged 04, from 
whom five stones had been removed, died afterwards from inflammation of the 
pelvic cellular tissue. A man, aged 71, from whom two stones had been re- 
moved, died of pelvic inflammation with peritonitis. 

Operations for Hernia. — During the half year the operations for strangulated 
hernia have been 54 in number, and the fatality therefrom 16 or 1 in 3.4. We 
will examine first the evidence they afford as to the much debated question of 
sac-opening. Out of the above number the sac was opened in 35, w^fch 11 deaths, 
or 1 in 3.2; it was not opened in 19, Avith a fatality of 5, or 1 in 3.8. We are 
not able to state with precision the duration of strangulation in quite all the 
cases, but of 29 of those in which the sac was opened its average was 59 hours ; 
while of 17 of those in which the sac was left unopened, its average was but 
42 hours. In one of the fatal cases in which the sac had not been opened death 
was from bronchitis, and not from the abdominal lesion ; and in three of those 
in which it had been opened death was almost inevitable at the time of the 
operation, in one from gangrene of the bowel, and in two from internal stric- 
tures. It does not appear, therefore, that from the past six months' experience 
any conclusions can be deduced in favour of the modern practice of endeavour- 
ing to accomplish reduction without opening the sac ; and there are several col- 
lateral circumstances which, if borne in mind, make this yet more apparent. 
It must be remem))ered, in the first place, that among those cases in which the 
sac was finally opened, are many in which the operator endeavoured to avoid 
doing so, and only adopted that expedient after more or less prolonged en- 
deavours to reduce without had failed, and consequently the parts had under- 
gone much unnecessary handling. Secondly, those selected for reduction with- 
out opening of the sac, have always been the more promising cases, it being 
accepted as a rule of practice, to examine the intestine whenever there is con- 
sidered to be risk of its being gangrenous or inflamed past recovery. On such 
a mere driblet of statistical data as that afforded by 54 cases, it would, of course, 
be absurd to attempt to ground any positive conclusion, especially on so im- 
portant a question in practical surgery. It must, however, be considered as to 
a certain extent neutralizing the deductions of the advocates of Petit's opera- 
tion, since those deductions are not themselves grounded on very extended ob- 
servation s.^ 

^ In case an old edition (the fourth) of Druitt's Surgeo7i^s Vade 3Iecum should 
be in the hands of any of our readers, we must take this opportunity of correcting a 
statement regarding Mr. Luke's experience of hernia operations which has found its 
way into that generally accurate work. It is to the effect, that out of forty cases 
operated on since Mr. Luke adopted Petit's method, only two had done badly; and is 
so palpably too good to be true, that the exposure of its fallacy is, perhaps, scarcely 
necessary. Mr. Luke's real statistics on this point are given in an excellent paper by 
himself in vol. xxxi. of the Medico- CMrurgical Transactions, and show (speaking 
roughly), in cases in which the sac had been opened, a fatality of 1 in 8.1 ; and in those 
in which it was not opened, a fatality of 1 in 8.4. Mr. Luke has kindly furnished us 
with a statement of the cases in which he lias operated since the publication of that 
paper (up to the beginning of 1853), which are 47 in number. Out of the whole, 
16, or 1 in 3, died; out of 21 in which the sac Avas opened 11, or more than one-half, 
died; while of 26 in which it was left unopened, only 5, or less than one-fifth, died. 



262 



Progress of the Medical Sciences. 



[July 



There are other points in the prognosis of a hernia case probably of much 
more vital importance than the mere question as to whether or not the sac has 
been opened. Such, for instance, as the duration of strangulation, the tight- 
ness of the constriction, the amount and violence of the efforts at taxis previ- 
ously resorted to, the size of the tumour, and the health of the patient. We 
regret that we o.re not able to make a strict analysis of the cases under con 
sideration in respect to each of these several heads; we will do so, however, as 
regards the first and most important of them. The length of time which stran- 
gulation had endured before the operation, is known, as we have already stated, 
in 46 of the cases. Of these the period was less than 12 hours in 11 cases, 
only 2 of which ended in death, and in 1 of those the rupture was of enormous 
size, and several feet of bowel exposed during the reduction. Between 12 and 
2-1 hours, there were 8 cases with 2 deaths. Between one and two days, there 
were 4 cases, with 1 death. Between two and three days, 1 case successful. 
Between three and four days, 7 cases, with 3 deaths. Between four and five 
days, 2 cases, both successful. Between five and six days, 2 cases, with 1 death. 
Between six and seven days, 2 cases, both of which died. These facts exhibit 
clearly enough the evil influence exerted by lengthened strangulation; and the 
lesson becomes yet more forcible, when it is recollected that, in many of those 
in which the period extends over several days, it is probable that the constric- 
tion was at first not very tight, while those in v/hich operation was done early 
are those in which, from the occurrence of very severe S3'mptoms at the outset, 
the sufterer was obliged at once to obtain efficient advice. It is impossible, per- 
haps, to express too strongly the importance of not losing time in cases of stran- 
gulated hernia. If moderate efforts at the taxis, made under chloroform, and 
after a warm bath, have failed, the loss of time involved in the trial of other 
expedients is attended by much greater risk of evil than promise of benefit. 

Amputations. — The number of capital amputations performed during the 
period specified has amounted to 84, out of which there have been 63 recoveries 
and 21 deaths. 

Of the Thigh. — 21; recovered, 13; died, 8. Primary amputations after acci- 
dent, 2, with 1 recovery and 1 death. Secondary amputations after accident, 
4, with 1 recovery and 3 deaths. Amputations for diseased knee-joint, 13, with 
9 recoveries and 4 deaths. Amputations for ulcerated leg and for painful 
stump, 2, 1 each ; both recoveries. 

Of the Leg. — 26; recovered, 15; died, 11. Primary, 13, with 6 recoveries 
and 7 deaths ; 4 of these were double amputations, all of which ended fatally. 
Secondary, 2, both of which recovered. For diseased ankle-joint, diseased tar- 
sus, senile gangrene, or ulcerated leg, 11, with 7 recoveries and 4 deaths. 

Of the Upper Extremity. — 25, all of which recovered ; 1 was through the 
scapula, 3 were at the shoulder-joint, 11 were through the upper arm, and 9 
through the forearm. 

Of the Rand or Foot. — 12 ; of which 10 recovered and 2 died — both the latter 
of tetanus; 3 were amputations at the ankle-joint; 1 Chopart's operation; 1 
tarso-metatarsal; and 1 of the entire foot, excepting the astragalus; 2 were at 
the wrist-joint; and 4 through the carpus, the greater part of the hand being 
removed. The cases which ended in tetanus were both primary amputations; 
one of them of part of the hand, and the other of the foot, at the astragalo- 
scaphoid joint. 

Among the causes of death, speaking of the amputations generally, we may 
notice the following: Shock of the operation in 4 cases, 3 of which were pri- 
mary amputations of both legs ; phlebitis and pyaamia, ascertained in 2 cases, 
and supposed in 3 others ; exhaustion from long-continued discharge, etc., 4 ; 
secondary hemorrhage occurred in 5, and was the cause of death in 3. The 
difference in result of amputations performed on the upper and lower extremity 
is well illustrated by the above facts. Thus we have in the latter, taking only 
operations done below the knee, a fatality of 1 in 2.6, and among those on the 
upper extremity, although 4 of them were at or above the shoulder-joint, a 
fatality of only i in 31. This is probably in part a mere coincidence, and the 
disproportion might not be found so extreme on generalization of a larger num- 
ber of facts. — J/ec/. Times and Gaz. March 18, 1854. 



1854.] 



Midwifery, 



263 



MIDWIFERY. 

53. Double Vterus — Ticins. By M. IIohl, — A delicate woman, aged 30, en- 
ceinte for the second time, became subject to slight and transitory hemorrhages 
during the first three m^onths of pregnancy. At the beginning of the seventh 
month, hemorrhage returned, and recurred in fourteen days. Both sides of the 
abdomen were convex and distended, but there was depression along the mesial 
line, from the umbilicus to the pubes. Here percussion caused a tympanitic 
sound ; on either side there was dulness. The uterus, which could be examined 
through the abdominal parietes, was divided into two parts, an inch and a half 
above the symphysis pubis, the right being larger than the left. Both were 
convex externally, concave internally, and presented the usual characters of 
the gravid uterus. The two cornua extended above the level of the umbilicus, 
and were sufficiently large for the hand to feel different parts of the foetus; in 
one, the beatings of the foetal heart were heard. The vagina was normal ; the 
neck of the uterus single, short, but larger than natural; it was about an inch 
wide. The two cornua could be felt superiorly opening into the cavity right 
and left. The orifice of the right cornu contained the placenta. Across the 
opening of the left cornu, the other placenta was felt. This, then, was a case 
of twins in a bicorned uterus. The two placentfB were implanted in the neck; 
one was disengaged, and the hemorrhage resulting from this disposition was 
sufficiently serious to call for interference. 

M. Ilohl determined promptly to bring on delivery. lie introduced the hand 
first into the right uterus, seized the feet, and dragged away the child without 
difficulty: the placenta followed at once. He repeated the same experiment, 
successfully, on the opposite side. The two infants, who weighed about three 
pounds, died after a few inspirations. 

The woman suffered from an attack of pleurisy, but she recovered in four 
weeks. 

The accuracy of the diagnosis was verified subsequently by examination both 
with the hand and the uterine sound. — J/ecZ. Times and Gaz. April 22, 1854, 
from Prager Yierteljahrschr, 1853. Bd. 4. 

54. CMoroform in Midiciferij. By S. W, J. Merriman. — INIrs. Manning, aged 
28, Irish, rather depressed from want of proper comforts, and from a liarass- 
ing cough, was found by me about 3 A. M., Nov. 21, 1848, in strong labour 
with her fourth child, though only third pregnancy. The os uteri was fully 
dilated, the bag of waters half way down the vagina, and the head lying in the 
natural position (vertex to right acetabulum) above the pubes; the pains very 
frequent and severe, all indicative of a speedy termination to the labour. 

The membranes broke almost immediately, but the head did not descend as 
I expected ; it seemed as if the pains propelled it against the pubes, and not in 
the axis of the brim. 

This condition having lasted an hour without any progress being made, though 
the patient's sufferings were very great, I requested the assistance of Mr., now 
Dr., Hawkesley, and submitted to him the question, whether we should admin- 
ister chloroform, then recently much vaunted as a safe agent in parturition. 

Both of us had strong feelings against its indiscriminate use; but it seemed 
to us that, if anaesthesia was ever to be induced with propriety in a natural 
labour, this was a fair case in which to try its efficacy. It would, we hoped, 
relieve the patient from those pains which agonized her so much, while the 
natural labour pains would proceed in their regular course, and shortly bring 
the child into the world. Dr. Hawkesley, therefore, administered the chloro- 
from by a mouth-piece, closely resembling that used by Dr. Snow, and the patient 
speedily passed into the third stage of narcotism of that eminent physician. 
For a moment the pains ceased, but they presently returned with the same 
strength as previously, and forced down a scalp tumour, but did not propel the 
head itself, though it frequently appeared to descend a little. Moderate pres- 



264 



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[July 



sure, applied at first by the hand, and afterwards by means of a binder, was 
used to direct the head more backwards, but inefiectually. 

Two hours elapsed in this manner, at the end of which we determined to try 
the effect of ergot, in inducing a consentaneous action of the whole of the 
uterine fibres. Three successive doses of the infusion of ergot were therefore 
given, but, instead of an increase of pains, they subsided, and presently ceased 
altogether. At this time a pain, of which the patient had previously complained, 
appeared to be settled in the abdomen, over the fundus uteri. She had retch- 
ings from time to time, bringing up not more than a teaspoonful of dark fluid. 
She was exhausted, but there was no collapse; the pulse was quiet, and of a 
fair strength. We gave her forty minims of Battley's laudanum, and left her 
at half-past 8 A. M. 

At half-past twelve noon, I saw her again; she had had no pains, but com- 
plained much of tenderness of the abdomen over the fundus uteri; the vomit- 
ings continued as before, but rather more fluid was thrown up ; the pulse small 
but regular; still nothing which could be called collapse. I was somewhat 
alarmed at not being able to feel by the "toucher" any part of the child's head ; 
but, as the case did not appear to be very urgent, and I had to attend some pa- 
tients at a considerable distance, I called upon Dr. Ilawkesley to request him 
to visit the poor woman in a short time. This, however, he was prevented from 
doing till nearly 5 P. M., when he gave her two grains of opium and two of 
calomel, and ordered her saline draughts, with tinct. opii tib^j every two hours. 
I now returned, and, after consulting together, we applied to Dr. Chowne, the 
principal physician to the Charity, who very promptly attended, passed his hand 
into the uterus, which he found largely dilated, but not ruptured, seized the 
child by the feet, and completed the delivery (footling) at about 6f P. M. The 
placenta followed forthwith, and the uterus contracted firmly as its contents 
were withdrawn, but there was no attempt at any contractions to expel the child 
or the placenta. 

My patient required very great attention on my part, and I am happy to say 
that by degrees she recovered sufficiently to go out. The details of this subse- 
quent treatment are not necessary here, and are given at full length in The Re- 
cord; suffice it to say, that it consisted mainly of salines with more or less 
laudanum in each dose, some calomel, and several eneraata to act on the bowels, 
and dispel wind which distended her very much. The vomiting gave place to 
purging on the evening of the 24th, and an improved condition began to show 
itself in her about that time. On the 26th, milk appeared in the breasts ; on 
the 29th, chalk and catechu became necessary to stay the diarrhoea, and shortly 
afterwards she had a tonic consisting of infusion of gentian with sal volatile. 

"Jan. 11, 1849. — She has been twice doAvn to the next floor, and talks of going 
out next week; feels a bearing down and pain in the left groin after standing a 
little, but this appears to be the effect of weakness ; she has a little leucorrhoea, and 
reports a slight catamenial period a few daj^s ago." About a year afterAvards, 
I heard from a neighbour that Mrs. Manning had been placed in a lunatic asy- 
lum, but m3Mnformaut could give me no other particulars. 

The fact that chloroform can and does induce inertia of muscular fibre, both 
voluntary and involuntary, when given in a sufficient dose, is now well-estab- 
lished ; 1 have, therefore, no hesitation in expressing my belief that the relaxation 
of the uterus in the case of Mrs. Manning was brought about through the inertia 
caused by deep inhalation of the chloroform, and I was anxious to bring the 
case before the Fellows of the Society, as a proof that chloroform may produce 
alarming results in midwifery practice, and that, if given at all, it should be in 
small quantities only. Time, however, did now allow any lengthened details, 
and I was obliged to be content with a very brief allusion to the case. 

In my Arguments Against the Indiscriminate Use of Chloroform in Midwifery, 
published in July, 1848, I advocated its omission altogether, as in olden times, 
but said that I could conceive cases in which its use might be allowed. The 
case I have described seemed to afford an opportunity for testing the soundness 
of my conceptions, and the confidence which could be placed in the panegyrics 
bestowed upon its use by accoucheurs in various parts of Great Britain. 



1S54.] 



Midwifery. 



265 



The result of my experiment I have described, and it was of so decided a 
character, that I have not used chloroform since, except in some cases of opera- 
tion ; and in several instances in -which I have been compelled to use the for- 
ceps to deliver the child, the arrest having been at the outlet, I have performed 
the operation without any resort to ansesthesia, and I have never had cause to 
regret my indisposition to place my patient in what I must call an unnatural 
condition. 

The more I hear and see of the, use of chloroform in midwifery, the more I 
am convinced, that though it may occasionally be useful, and even desirable, in 
the small quantities now administered in London, in bringing about a relas-a- 
tion of a rigid os uteri, as mentioned by Dr. Gream ; or in larger doses to relax 
the rigid contraction round the body of a child impacted in the pelvis in an arm 
presentation, where turning must be accomplished, or the child be eviscerated, 
its administration is not desirable in ordinary cases ; and that whenever it is 
administered, great attention should be paid to its effect on the sensorial func- 
tions, lest a serious injury should ensue to the patient, a caution which can only 
be properly carried out by the administration of the ansesthetic being confided 
to a second practitioner, who shall not take part in the superintendence of the 
actual birth. 

P. S. Dr. Chowne has just informed me, that Mrs. Manning " devoted herself 
(after regaining her strength) to religion, fasting, etc.; that she appeared odd 
in her ways, but remained sane up to the end of four months. At the end of 
two months more, making six from her confinement, she was in a lunatic asy- 
lum." — ^ed. Times and Gaz. April 22, 1854. 

55. Cases of Hysteria and Spurious Pregnancy. — Dr. Alexander Ketller re- 
lated the following remarkable case at a meeting of the Medico-Chirurgical 
Society of Edinburgh, xlpril 5, 1854. Dr. K. first saw the patient, Elizabeth 
Berry, on the 14th September, 1838, in Dundee. She was then nineteen years 
of age, and her symptoms were those of uterine derangement, with hysteria. 
The abdomen was tympanitic ; pain was complained of in the right side; there 
were acid eructations : the bowels were confined, and the catamenia suppressed. 
On inquiry, it was found that she had always been a delicate child, and even 
in infancy had suffered from an enlarged belly. The catamenia appeared in 
her fifteenth year, and had become irregular, apparently in consequence of a 
severe bruise which she had received shortly after their appearance. lie lost 
sight of her till about nine months afterwards, when he learned that she was con- 
sidered to have been in labour for many days, and that she was attended by an un- 
qualified practitioner, who regarded the case as one of such extreme difficulty, 
that the Csesarean section was proposed as the only means of relief. On the 
25th June, he was asked to see her, and rather to his surprise found that he 
could not detect any uterine tumour. The os was completely closed, and the 
usual mammary signs were wanting. The uterus was of the usual unimpreg- 
nated development, and of course the idea of pregnancy was at once dismissed 
from his mind. The abdomen, however, was enlarged, and tender to the touch. 
The pulse was 120, full and bounding. The girl was evidently in a state of 
nervous excitement. He ordered an opiate and turpentine enemata, etc. The 
abdomen continued to enlarge, and the nervous symptoms to increase in severity, 
notwithstanding the liberal use of narcotics and other remedies. The pain was 
not relieved, and her supposed labour screams disturbed the whole neighbour- 
hood. On August 20, she commenced to vomit bloody mucus, which, from its 
accumulation, prevented sleeping and threatened snfibcation. The menstrual 
discharge was noted to have appeared on the 15th September, but, as usual, to 
have been a mere show. The pulse was still 120. Four ounces of bloody mu- 
cus were passed from the mouth. On the 22d of the same month, she was care- 
fully examined. When erect, the abdomen presented an enormous enlargement, 
but no fluctuation or enlarged organ could be detected. Its left side was larger 
than the right. There was marked spinal irritation, and the left lower extremity 
was found slifrhtiy contracted on the trunk. In the upright position the pulse 
was 160. The contraction of her limb increased in extent, and she soon began 
to vomit her food. All her symptoms, however, began to decline in severity in 



266 



Progress of the Medical Sciences. 



[July 



March of the following year, 1839 ; and forty-eight weeks after the commence- 
ment of her illness!, she was able to wnlk out a little in the open air. She was 
speedily reduced to her former state of helplessness in consequence of a sudden 
fright, from the averments of a quack that her belly contained a living viper. 
Again various plans of treatment were put in requisition without success, and" 
change of air was insisted upon, which was always attended with marked relief 
to the general symptoms, though the size of the abdomen remained unchanged. 
She returned from one of these removals in Feb. 1841, so well, as to be able to 
resume her former duties at a mill: the abdomen was decreased in size, though 
still enlarged ; the catamenia were irregular as before ; and her aspect very 
hysterical. In a fortnight, her old symptoms reappeared, and compelled her 
again to take to bed. After a short stay in the Dundee Infirmary, she once more 
went in quest of change of air, and was not seen by -Dr. Keiller till 1849, when 
she consulted him in Edinburgh on account of the threatened recurrence of her 
former complaints, her abdomen being very large and tympanitic. [During the 
eight years which had elapsed, she had, it seemed, become pregnant, and been 
delivered of a living child. Her abdomen continued so large during this her 
true pregnancy, that it had not been suspected till the child made its appear- 
ance.] She was sent into the Maternity Hospital on the 8th of June, 1849 ; and 
on the 10th, his attention was drawn to the supposed fact that she was passing 
per ureihram., a liquid exactly resembling a mixture of urine and writing ink. 
The catheter was used, and pale urine was drawn off. On the II th, she was 
examined by Dr. Simpson, who was inclined to refer a dulness in the left iliac 
fossa, observable on percussion, to the uterus having been tilted over. Chlo- 
roform was now administered (for the first time, Dr. Keiller believed, in the 
diagnosis of such a case), and the abdomen became quite flat. The uterus was 
ascertained to be of natural size, but the bladder was very large and distended 
with pale urine. On the effects of the chloroform passing off, the abdomen re- 
gained its former enlargement. The chbroform was again administered a few 
days after, and similar effects followed ; the spinal column being easily traced 
through the abdominal parietes. She remained for a month under treatment 
of a varied character, and left for Dundee, but slightly, if at all, improved. 
About two years ago, he had again seen her ; but, as since then she liad es- 
caped his notice, he could not at present give any account of her state of health. 

In conclusion, Dr. Keiller stated that in a somewhat similar case at present 
under his care in the Koyal Infirmary, chloroform had been attended with 
similar results, and that the abdominal tumour had also diminished during the 
action of galvanism. It was his intention on some future occasion to bring this 
interesting subject more fully before the Society. 

Dr. W. T. Gairdner had perused an essay lately published by VLv. More 
O'Ferral, of Dublin, on Abdominal Tympany, in which a similar observation on 
the use of chloroform in the diagnosis of such cases was made, but with no 
mention of the previous investigations of Dr. Simpson. It was interesting, 
however, to find a collateral and independent testimony to the value of the 
agent. 

The President said, that his own observations on the use of chloroform in the 
diagnosis of such cases would be found in the same journal, at least three or 
four years before the appearance of Mr. O'Ferral's paper. He believed that 
cases of spurious pregnancy were often met with in practice; for many a mar- 
ried lady would acknowledge, when questioned, that she had once or twice 
thought herse